Brain metastasis and endometrial cancer: histology, stage, and patterns of recurrence

Objectives: We hypothesize that women with brain metastases from endometrial cancer (EC) will share similar features of histology, initial stage, and time to recurrence. Methods: A retrospective chart review was performed with case identification through Natural language processing with Deep6 AI to identify all patients with endometrial cancer and bone metastasis at our institution between 2010 and 2020. Patient demographics, stage, grade, timing of metastasis and other characteristics were recorded. Standard statistical analyses were used to analyze the data. Results: Twelve patients who met study inclusion were identified. The median age at initial diagnoses was 61 years. Two patients (16%) were diagnosed with brain metastasis at initial diagnosis of EC. Patients were equally distributed between stage I, III and IV with 4 patients (33%) in each group. Histology divided between serous (41%) Endometrioid (41%) Dedifferentiated (8%) and Mixed (8%) at diagnosis. Of endometrioid tumors(n=5) all were grade II. Mismatch repair (MMR) status was available for 4 patients (33%) patients and of those 1 was positive for MLH1 Mutation. In those patients who did not have brain metastasis present on initial diagnosis the median time from initial diagnosis to first location of recurrence was 24 months (Range 4-107 months) and to brain metastasis was 41 months (Range 4-140 months). Of those patients who had recurrent disease then progressed to brain metastasis, the median time from initial recurrence to brain metastasis was 25.5 months (Range 4-116 months). Other locations of recurrence included bone, lungs, liver, and mediastinum. Treatment for the brain metastasis varied widely but the most common was radiation which was included in the therapy of 77% of those treated. 22% had surgery which was combined with radiation or other systemic therapy. One patient with leptomeningeal disease was treated with intrathecal methotrexate. Download : Download high-res image (101KB) Download : Download full-size image Conclusions: Patients with brain metastasis from endometrial cancer tend to have higher grade and stage tumors at initial diagnosis. They have varying histology, presenting stage, and time to recurrence. Time of progression of initial non-brain recurrence to brain metastasis varies greatly. Further study is required to define patterns and timing of recurrence so treatment and counseling on risks can be optimized.