Brain Metastasis in Endometrial Cancer: A Systematic Review

Abstract

Background: Brain metastases (BMs) from endometrial cancer (EC) are rare and challenging to treat, with limited standardized guidelines. This systematic review aims to evaluate the incidence, therapeutic strategies, and outcomes associated with brain metastases in EC patients, offering insights for clinical practice and future research.

Methods: A comprehensive literature search was conducted using PRISMA guidelines, including PUBMED up to October 2024. Reports reporting individual or aggregate data on EC brain metastases were included. Descriptive and quantitative analyses were performed on incidence, treatment modalities, and survival outcomes. Three reports that used data from the Surveillance, Epidemiology, and End Results and National Cancer Database were used only to assess the incidence of brain metastases from endometrial carcinoma.

Results: From 911 reports identified, we included 99 reports, identifying 594 cases; these and the case of a patient with brain metastasis from endometrial carcinoma followed at our center were used for analysis of disease characteristics; incidence; and treatment modalities, such as surgery, radiotherapy, chemotherapy, and combinations. Survival outcomes were influenced by treatment type and disease characteristics, with multimodal approaches showing improved outcomes.

Discussion: This review underscores the rarity of EC brain metastases and highlights the need for tailored, multimodal treatment strategies. Future research should focus on prospective trials and molecular profiling to optimize management.

Keywords: brain metastasis; endometrial carcinoma; immune checkpoint inhibitor; radiotherapy; stereotactic radiotherapy; target therapy.

Figure 1

Literature review according to PRISMA 2020 method.

Figure 2

Median survival in patients with isolated brain metastasis and no extracranial disease, isolated brain metastasis and extracranial disease, multiple brain metastasis and no extracranial disease, and multiple brain metastasis and extracranial disease.

Figure 3

Median survival and treatment in all patients, patients with isolated brain metastasis and no extracranial disease, isolated brain metastasis and extracranial disease, multiple brain metastasis and no extracranial disease, and multiple brain metastasis and extracranial disease. * 1 patient; ** 2 patients. BM brain metastasis; RT radiotherapy; S surgery; SRS stereotactic radiotherapy; ST systemic therapy.

Figure 4

Effect of radiotherapy, immunotherapy, and TKI inhibitor. CD8+ T cell: cytotoxic T lymphocyte, MHC-I: major histocompatibility complex class I, TCR: T cell receptor, PD-1: programmed cell death protein 1, PD-L1: programmed death-ligand 1, FGFR: fibroblast growth factor receptor, IL-1: Interleukin 1, TNF: tumor necrosis factor, ICAM-1: intercellular adhesion molecule 1, VCAM: vascular cell adhesion molecule 1.