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Hematogenous metastases in patients with Stage I or II endometrial carcinoma

Hämatogene Metastasierung bei Patientinnen mit Endometriumkarzinom im Stadium I und II

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Abstract

Aims

The aim of this study was to present the characteristics, methods of treatment, and the survival of patients with hematogenous metastases from endometrial carcinoma, free from local and other distant recurrences.

Patients and Methods

In 1,610 endometrial carcinoma patients managed with surgery and postoperative radiotherapy, we defined hematogenous metastases as a tumor spread to the lung or other sites via hematogenous routes.

Results

A total of 110 patients with stage I and II endometrial carcinoma, presenting with 134 metastases sites (69 in the lungs, 32 in the liver, 23 in the bones, and 10 in the brain), were observed. Progestin and combination chemotherapy were the most commonly used therapies. Primary treatment consisted of surgery in patients with solitary metastases to the lung (30 patients), liver (2 patients), and brain (2 patients). Radiotherapy was performed in 32 patients with metastases to the brain and bones. Presenting with a 36-month survival rate were 11.6% (8/69) of patients with metastases to the lungs, 6.3% (2/32) of patients with metastases to the liver, 8.7% (2/23) of patients with metastases to the bones, and 20.0% (2/10) of patients with metastases to the brain.

Conclusions

Hormonal therapy and chemotherapy play a major role in the palliative management of patients with hematogenous metastases from endometrial carcinoma to the liver, lungs, and bones. Radical treatment in patients with metastases to the lung or liver consists of resection of the metastasis combined with chemo- and/or hormonotherapy for metastases to the bones treatment consists of radiotherapy + chemotherapy, for metastasis to the brain treatment consists of resection combined with radiotherapy.

Zusammenfassung

Ziel

Darstellung von Charakteristika, Behandlungsmethoden und Überleben von Patientinnen mit hämatogenen Metastasen des Endometriumkarzinoms ohne lokalen und Fernrezidive.

Patienten und Methoden

Bei 1610 Patientinnen mit Endometriumkarzinom, die mit Operation und postoperativer Strahlentherapie behandelt worden waren, definierten wir hämatogene Metastasen als Ausbreitung bösartiger Tumoren in die Lungen oder andere Regionen über die Blutbahn.

Ergebnisse

Wir beobachteten 110 Endometriumkarzinom-Patientinnen, Stadien I und II, bei denen 134 Metastasenlokalisatione festgestellt wurden: 69 in den Lungen, 32 in der Leber, 23 in den Knochen und 10 im Gehirn. Die am häufigsten eingesetzten Behandlungsregime waren Progestine und Kombinationschemotherapie. Erstbehandlung waren Operationen bei Patientinnen mit einzelnen Lungenmetastasen (30 Fälle), Lebermetastasen (2 Fälle) und Gehirnmetastasen (2 Fälle). Eine Strahlentherapie wurde bei 32 Patienten mit Gehirnmetastasen und mit Knochenmetastasen durchgeführt. Nach 36 Monaten betrug die Überlebensrate 11,6% (8/69) der Patientinnen mit Lungenmetastasen, 6,3% (2/32) der Patientinnen mit Lebermetastasen, 8,7% (2/23) der Patientinnen mit Knochenmetastasen und 20,0% (2/10) der Patientinnen mit Gehirnmetastasen.

Schlussfolgerung

Hormon- und Chemotherapie spielen eine wesentliche Rolle in der palliativen Behandlung von Patientinnen mit hämatogenen Leber-, Lungen- und Knochenmetastasen des Endometriumkarzinoms. Die radikale Behandlung bei Lungen- oder Lebermetastasen umfasst chirurgische Metastasenresektion und adjuvante Chemo- und/oder Hormontherapie, bei Knochenmetastasen Strahlen- plus Chemotherapie und bei Gehirnmetastasen chirurgische Metastasenresektion und adjuvante Strahlentherapie.

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References

  1. Aalders JG, Abeler V, Kolstad P. Recurrent adenocarcinoma of the endometrium: a clinical and histopathological study of 379 patients. Gynecol Oncol 1984;17:85–103.

    Article  PubMed  CAS  Google Scholar 

  2. Aalders JG, vd Syde R, Poppema S et al. Prognostic factors and changing trends in the treatment of stage I endometrial cancer: a clinical and histopathological study of 182 patients. Int J Radiat Oncol Biol Phys 1984;10:2083–8.

    Article  PubMed  CAS  Google Scholar 

  3. Aapro MS, van Wijk FH, Bolis G et al. Doxorubicin versus doxorubicin and cisplatin in endometrial carcinoma: definitive results of a randomised study (55872) by the EORTC Gynaecological Cancer Group. Ann Oncol 2003;14:441–8.

    Article  PubMed  CAS  Google Scholar 

  4. Anderson TM, McMahon JJ, Nwogu CE et al. Pulmonary resection in metastatic uterine and cervical malignancies. Gynecol Oncol 2001;83:472–6.

    Article  PubMed  CAS  Google Scholar 

  5. Arvold DS. Right ventricular metastasis of endometrial carcinoma: a case report. Gynecol Oncol 1988;29:231–3.

    Article  PubMed  CAS  Google Scholar 

  6. Ballon SC, Berman ML, Donaldson RC et al. Pulmonary metastases of endometrial carcinoma. Gynecol Oncol 1979;7:56–65.

    Article  PubMed  CAS  Google Scholar 

  7. Bottke D, Wiegel T, Kreienberg R et al. Stage IB endometrial cancer. Does lymphadenectomy replace adjuvant radiotherapy? Strahlenther Onkol 2007;183:600–4.

    Article  PubMed  Google Scholar 

  8. Bouros D, Papadakis K, Siafakas N et al. Natural history of patients with pulmonary metastases from uterine cancer. Cancer 1996;78:441–7.

    Article  PubMed  CAS  Google Scholar 

  9. Bouros D, Papadakis K, Siafakas N et al. Patterns of pulmonary metastasis from uterine cancer. Oncology 1996;53:360–3.

    Article  PubMed  CAS  Google Scholar 

  10. Campagnutta E, Giorda G, De Piero G et al. Surgical treatment of recurrent endometrial carcinoma. Cancer 2004;10:89–96.

    Article  Google Scholar 

  11. Capeáns C, Santos L, Sánchez-Salorio M et al. Iris metastasis from endometrial carcinoma. Am J Ophthalmol 1998;125:729–30.

    Article  PubMed  Google Scholar 

  12. Carl UM, Bahnsen J, Edel B et al. The value of a postoperative radiation therapy in FIGO stage I and II endometrial cancers. Strahlenther Onkol 1995;171:322–5.

    PubMed  CAS  Google Scholar 

  13. Chi DS, Fong Y, Venkatraman ES et al. Hepatic resection for metastatic gynecologic carcinomas. Gynecol Oncol 1997;66:45–51.

    Article  PubMed  CAS  Google Scholar 

  14. Chura JC, Marushin R, Boyd A et al. Multimodal therapy improves survival in patients with CNS metastasis from uterine cancer: a retrospective analysis and literature review. Gynecol Oncol 2007;107:79–85.

    Article  PubMed  Google Scholar 

  15. Cormio G, Lissoni A, Losa G et al. Brain metastases from endometrial carcinoma. Gynecol Oncol 1996;61:40–3.

    Article  PubMed  CAS  Google Scholar 

  16. Corn BW, Lanciano RM, D’agostino R et al. The relationship of local and distant failure from endometrial cancer: defining a clinical paradigm. Gynecol Oncol 1997;66:411–6.

    Article  PubMed  CAS  Google Scholar 

  17. Creutzberg CL, van Putten WL, Koper PC et al. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol 2003;89:201–9.

    Article  PubMed  Google Scholar 

  18. De Porre PM, Subandono Tjokrowardojo AJ. Brain metastases of endometrial carcinoma: case report and review of literature. Strahlenther Onkol 1992;168:100–1.

    PubMed  Google Scholar 

  19. Descamps P, Calais G, Moire C et al. Predictors of distant recurrence in clinical stage I or II endometrial carcinoma treated by combination surgical and radiation therapy. Gynecol Oncol 1997;64:54–8.

    Article  PubMed  CAS  Google Scholar 

  20. D’Orsi CJ, Bruckman J, Mauch P et al. Lung metastases in cervical and endometrial carcinoma. Am J Roentgenol 1979;133:719–22.

    Google Scholar 

  21. Fujimoto T, Nanjyo H, Fukuda J et al. Endometrioid uterine cancer: histopathological risk factors of local and distant recurrence. Gynecol Oncol 2009;112:342–7.

    Article  PubMed  Google Scholar 

  22. Gien LT, Kwon JS, D’souza DP et al. Brain metastases from endometrial carcinoma: a retrospective study. Gynecol Oncol 2004;93:524–8.

    Article  PubMed  Google Scholar 

  23. Gücer F, Yilmaz O, Balkanli-Kaplan P et al. Complete remission of an endometrial carcinoma with bilateral multiple pulmonary and extrapelvic metastases treated by surgery and chemotherapy consisting of paclitaxel and carboplatin. Int J Gynecol Cancer 2005;15:1160–2.

    Article  PubMed  Google Scholar 

  24. Hängsen G, Nagel M, Dunst J et al. Postoperative radiotherapy in endometrial carcinoma. A retrospective analysis of 541 cases. Strahlenther Onkol 1999;175:548–53.

    Article  Google Scholar 

  25. Havrilesky LJ, Secord AA, O’Malley DM et al. Multicenter analysis of recurrence and survival in stage IIIA endometrial cancer. Gynecol Oncol 2009;114:279–83.

    Article  PubMed  Google Scholar 

  26. Heisterkamp C, Haatanen T, Schild SE et al. Dose escalation in patients receiving whole-brain radiotherapy for brain metastases from colorectal cancer. Strahlenther Onkol 2010;186:70–5

    Article  PubMed  Google Scholar 

  27. Humber CE, Tierney JF, Symonds RP, Collingwood M et al. Chemotherapy for advanced, recurrent or metastatic endometrial cancer: a systematic review of Cochrane collaboration. Ann Oncol 2007;18:409–20.

    Article  PubMed  CAS  Google Scholar 

  28. Jemal A, Siegel R, Ward E et al. Cancer statistics. CA Cancer J Clin 2007;57:43–66.

    Article  PubMed  Google Scholar 

  29. Kushner DM, Lurain JR, Fu TS et al. Endometrial adenocarcinoma metastatic to the scalp: case report and literature review. Gynecol Oncol 1997;65:530–3.

    Article  PubMed  CAS  Google Scholar 

  30. Kuten A, Grigsby PW, Perez CA et al. Results of radiotherapy in recurrent endometrial carcinoma: a retrospective analysis of 51 patients. Int J Radiat Oncol Biol Phys 1989;17:29–34.

    Article  PubMed  CAS  Google Scholar 

  31. Lanciano RM, Corn BW, Schulz DJ et al. The justification for a surgical staging system in endometrial carcinoma Radiother Oncol 1993;28:186–9.

    Article  Google Scholar 

  32. Mahmoud-Ahmed AS, Kupelian PA, Reddy CA et al. Brain metastases from gynecological cancers: factors that affect overall survival. Technol Cancer Res Treat 2002;1:305–10.

    PubMed  Google Scholar 

  33. Mahmoud-Ahmed AS, Suh JH, Barnett GH et al. The effect of radiation therapy on brain metastases from endometrial carcinoma: a retrospective study. Gynecol Oncol 2001;83:305–9.

    Article  PubMed  CAS  Google Scholar 

  34. Mariani A, Webb MJ, Keeney GL et al. Hematogenous dissemination in corpus cancer. Gynecol Oncol 2001;80:233–8.

    Article  PubMed  CAS  Google Scholar 

  35. Mariani A, Webb MJ, Keeney GL et al. Surgical stage I endometrial cancer: predictors of distant failure and death. Gynecol Oncol 2002;87:274–80.

    Article  PubMed  Google Scholar 

  36. Martínez-Mañas RM, Bell M, Rumià J et al. Brain metastases in endometrial carcinoma. Gynecol Oncol 1998;70:282–4.

    Article  PubMed  Google Scholar 

  37. McMeekin DS, Filiaci VL, Thigpen JT et al. Gynecologic Oncology Group study. The relationship between histology and outcome in advanced and recurrent endometrial cancer patients participating in first-line chemotherapy trials: a Gynecologic Oncology Group study. Gynecol Oncol 2007;106:16–22.

    Article  PubMed  Google Scholar 

  38. Meisner J, Meyer A, Polivka B et al. Outcome of moderately dosed radiosurgery for limited brain metastase report of a single-center experience. Strahlenther Onkol 2010;186:76–81.

    Article  PubMed  Google Scholar 

  39. Micke O, Bruns F, Halek G et al.. Long-term results of postoperative radiotherapy for stage I endometrial carcinoma. Strahlenther Onkol 2003;179:729–36.

    Article  PubMed  Google Scholar 

  40. Mountzios G, Bamias A, Voulgaris Z et al. Prognostic factors in patients treated with taxane-based chemotherapy for recurrent or metastatic endometrial cancer: proposal for a new prognostic model. Gynecol Oncol 2008;108:130–5.

    Article  PubMed  CAS  Google Scholar 

  41. Niwa K, Kometani K, Sekiya T et al. Complete remission of uterine endometrial cancer with multiple lung metastases treated by paclitaxel and carboplatin. Int J Clin Oncol 2002;7:197–200.

    Article  PubMed  Google Scholar 

  42. Otsuka I, Ono I, Akamatsu H et al. Pulmonary metastasis from endometrial carcinoma. Int J Gynecol Cancer 2002;12:208–13.

    Article  PubMed  CAS  Google Scholar 

  43. Petru E, Lax S, Kurschel S et al. Long-term survival in a patient with brain metastases preceding the diagnosis of endometrial cancer. Report of two cases and review of the literature. J Neurosurg 2001;94:846–8.

    Article  PubMed  CAS  Google Scholar 

  44. Pignata S, Scambia G, Pisano C et al. A multicentre phase II study of carboplatin plus pegylated liposomal doxorubicin as first-line chemotherapy for patients with advanced or recurrent endometrial carcinoma: the END-1 study of the MITO (Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies) group. Br J Cancer 2007;96:1639–43.

    Article  PubMed  CAS  Google Scholar 

  45. Sawada M, Inagaki M, Ozaki M et al. Long-term survival after brain metastasis from endometrial cancer. Jpn J Clin Oncol 1990;20:312–5.

    PubMed  CAS  Google Scholar 

  46. Shiohara S, Ohara M, Itoh K et al. Successful treatment with stereotactic radiosurgery for brain metastases of endometrial carcinoma: a case report and review of the literature. Int J Gynecol Cancer 2003;13:71–6.

    Article  PubMed  CAS  Google Scholar 

  47. Smith CJ, Heeren M, Nicklin JL et al. Efficacy of routine follow-up in patients with recurrent uterine cancer. Gynecol Oncol 2007;107:124–9.

    Article  PubMed  Google Scholar 

  48. Sneed PK, Lamborn KR, Forstner JM et al. Radiosurgery for brain metastases: is whole brain radiotherapy necessary? Int J Radiat Oncol Biol Phys 1999;43:549–58.

    Article  PubMed  CAS  Google Scholar 

  49. Sterzing F, Welzel T, Sroka-Perez G et al. Reirradiation of multiple brain metastases with helical tomotherapy. A multifocal simultaneous integrated boost for eight or more lesions. Strahlenther Onkol 2010;185:89–93.

    Article  Google Scholar 

  50. Tangjitgamol S, Levenback CF, Beller U et al. Role of surgical resection for lung, liver, and central nervous system metastases in patients with gynecological cancer: a literature review. Int J Gynecol Cancer 2004;14:399–422.

    Article  PubMed  CAS  Google Scholar 

  51. Thigpen JT, Brady MF, Homesley HD et al. Phase III trial of doxorubicin with or without cisplatin in advanced endometrial carcinoma: a Gynecologic Oncology Group study. J Clin Oncol 2004;22:3902–8.

    Article  PubMed  CAS  Google Scholar 

  52. Ucella S, Mariani A. Endometrial cancers. In: Ayhan A, Gultekin M, Dursun P (eds) Textbook of gynaecological oncology. Günes Publ. Ankara 2009;173–8.

    Google Scholar 

  53. Weitmann HD, Knocke TH, Waldhäusl C et al. Ultrasound-guided interstitial brachytherapy in the treatment of advanced vaginal recurrences from cervical and endometrial carcinoma. Strahlenther Onkol 2006;182:86–95.

    Article  PubMed  Google Scholar 

  54. Zusterzeel PL, Bekkers RL, Hendriks JC et al. Prognostic factors for recurrence in patients with FIGO stage I and II, intermediate or high risk endometrial cancer. Acta Obstet Gynecol Scand 2008;87:240–6.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Paweł Blecharz.

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Blecharz, P., Urbański, K., Mucha-Małecka, A. et al. Hematogenous metastases in patients with Stage I or II endometrial carcinoma. Strahlenther Onkol 187, 806–811 (2011). https://doi.org/10.1007/s00066-011-2250-6

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  • DOI: https://doi.org/10.1007/s00066-011-2250-6

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