Brain metastases from esophageal cancer

Abstract

Brain metastases deriving from esophageal cancer are very rare with scarce data available concerning these patients’ outcome. We, therefore, evaluated outcome after surgical resection followed by radiotherapy of brain metastasis from esophageal cancer. A retrospective analysis was conducted on consecutive patients undergoing resection of brain metastasis from esophageal cancer in 2 neuro-oncological centers between 2008 and 2018. Clinical and demographic data were retrieved from electronic patient charts. Post-treatment survival was calculated using Kaplan–Meier estimates. Twenty-five patients were identified. Treatment for primary disease comprised neo-adjuvant radio-chemotherapy followed by surgery (64.0%), surgery and adjuvant radio-chemotherapy (8.0%), radio-chemotherapy only (24.0%), and 1 patient receiving esophageal stenting only. Median time interval since initial diagnosis was 16 (range 0–110) months. All but 1 brain lesion were neurologically symptomatic and median Karnofsky performance score improved postoperatively from 70 to 80. After resection of brain metastases patients received whole-brain (n = 13 (52.0%)) or local fractionated (n = 9 (36.0%)) radiotherapy. In 2 patients adjuvant treatment was impeded by clinical deterioration; 1 patient refused radiotherapy. By the time of analysis 22 patients had died. Median survival after brain metastasis was 6 (95% CI 0.5–11.6) months. Survival after resection of metastasis from esophageal cancer is poor compared to other tumor entities. Nevertheless, resection of symptomatic brain metastases may improve clinical status in the context of a palliative concept.

Clinicopathological Features and Prognoses in Patients With Brain Metastases From Small-Cell Esophageal Carcinoma: A Retrospective Analysis of 18 Patients

“…The DS-GPA grading standard (3), commonly used in patients with BM from the digestive tract tumor, was used in this study. The study showed that the median OS of patients with the DS-GPA score of 2.5-4 points was significantly higher than that of patients with scores of 0-2 points, which is consistent with the previous reports on BM from a malignant tumor of the digestive tract (11). However, this study used the DS-GPA score to evaluate the prognosis of patients with BM from SCEC.…”

“…In the present study, male patients with BM from SCEC accounted for 55.6%, with a 5:4 male-to-female ratio. This male-to-female ratio was significantly lower than expected (84-87.5%) for patients with BM from ESCC/EAC (6,11). However, due to the small sample size, the relatively high female-to-male ratio of 44.4% for patients with BM from SCEC in this study remains to be confirmed.…”

Esophageal Adenocarcinoma Presenting as an Isolated Brain Lesion 6 Years After Treatment

“…Limited data suggest that the survival of patients with isolated CNS lesions is ,1 year. 13,14 Neoadjuvant chemoradiation therapy has shown long-term survival benefits in several studies. 15,16 However, the current literature lacks information on EAC specific genes that can predict metastases to the brain.…”

Outcomes and Molecular Features of Brain Metastasis in Gastroesophageal Adenocarcinoma

“…Brain metastasis (BrM) is a rare complication of gastroesophageal adenocarcinoma (GEA) [1][2][3][4][5] and is associated with neurologic morbidity and poor prognosis, with median survival historically reported to be in the range of 2 to 6 months after BrM diagnosis. 1,2,[5][6][7][8][9][10] Clinical risk factors for BrM development are poorly understood, although associations have been found with higher N stage and other metastases (particularly liver, lung, and bone). 5 In patients with surgically resected esophageal cancer, prior neoadjuvant therapy was also associated with the development of isolated BrM 4 ; however, this development may be confounded by the use of neoadjuvant therapy in patients with worse prognosis.…”

“…Brain metastasis (BrM) is a rare complication of gastroesophageal adenocarcinoma (GEA) and is associated with neurologic morbidity and poor prognosis, with median survival historically reported to be in the range of 2 to 6 months after BrM diagnosis . Clinical risk factors for BrM development are poorly understood, although associations have been found with higher N stage and other metastases (particularly liver, lung, and bone) .…”