NATURAL-HISTORY OF PATIENTS WITH PULMONARY METASTASES FROM UTERINE-CANCER

BACKGROUND. Endometrial cancer is the most common female genital cance r and approximately 90% of the cases are diagnosed while they are stil l confined to the uterus. However, the natural history and treated cou rse after the development of pulmonary metastasis (PM) have not been s tudied systematically in a large series of patients. METHODS. Between 1962 and 1999, 100 patients (6%) with PM were identified by computeriz ed search of the medical records from 1.665 patients admitted to our h ospitals with the diagnosis of uterine cancer. The median age of the p atients was 65.5 years (range: 42-87 yrs). The usual histologic types of the uterine neoplasms were 59 adenocarcinomas (59%), 21 sarcomas, a nd 14 adenosquamous carcinomas. Of the 83 patients with reported tumor grade, 11 had Grade 1 tumor, 12 Grade II, and 60 Grade III. RESULTS, Lung metastases were found at the time of diagnosis of the primary tum or in 22 patients. Hemoptysis was the first symptom in 3 of the 22; th e majority had no respiratory symptoms. In the remaining 78 patients w ith PM appearing after primary therapy, the mean interval time between primary diagnosis and PM was 29.4 months, whereas between PM and deat h was 15.7 months. Of all patients with lung metastases, 75% did not s urvive 1 year; however 6% survived more than 5 years after diagnosis o f metastatic disease. Patients with isolated PM had prolonged survival (36.1 mos, P = 0.001), whether treated medically or with pulmonary re section. Progestin therapy was given to 39 patients, with complete res ponse consisting of radiographic resolution of all disease in 6 patien ts (15%) and prolonged stabilization in an additional 5 (13%). The his tologic grade of the primary tumor was predictive of clinical response to progestine therapy. CONCLUSIONS. Asymptomatic pulmonary metastases represent a common site of extra pelvic spread of disease. The majori ty of patients with PM (75%) do not survive 1 year. Low grade uterine tumors are more likely to respond to progestin therapy and do so for e xtended periods of time. (C) 1996 American Cancer Society.