Gastrointestinal Cancer And Brain Metastasis: A Rare And Ominous Sign

Go, Pauline H.; Meadows, M.C.; Chamberlain, Ronald S.

doi:10.1016/j.jss.2010.11.189

Cited by 36 publications

(69 citation statements)

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“…However, in the majority of studies, the incidence of BM has probably been underestimated since, in most series, routine brain imaging is not typically part of the metastatic work-up. In the current study, the incidence of BM was 6%, which was slightly higher compared with previously published series (3)(4)(5)(6). Although patients with BM were not routinely evaluated with MRI in the present study, in four patients with neurological symptoms, cranial CT or MRI was performed to rule out BM.…”

Section: Discussioncontrasting

confidence: 57%

“…The most common metastatic sites include the lungs, liver, and bones (1). The incidence of brain oligometastasis (oligo-BM) is extremely rare (1-3% incidence in clinical series) (2,3). The majority of patients with BM are diagnosed at an advanced clinical stage, and the majority of BMs tend to occur together with other organ metastases (2,4,5).…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of aggressive treatment in esophageal cancer patients with synchronous solitary brain metastasis

Onal

Yıldırım

Güler

2017

Molecular and Clinical Oncology

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Abstract. The aim of the present study was to investigate the outcomes of esophageal cancer (EC) patients with isolated synchronous brain oligometastasis (oligo-BM) treated with chemoradiotherapy (CRT) of the primary site and localized treatment of the BM with surgery, radiotherapy (RT) or radiosurgery. Of 125 EC patients investigated, seven patients (6%) had solitary BM. Six patients were diagnosed prior to, and one patient was diagnosed during, treatment. All patients were treated with neoadjuvant chemotherapy and whole-brain RT (WBRT) for BM. All but one patient received definitive CRT with a median RT dose of 50.4 Gy using conventional fractionation RT. The median age at diagnosis was 59 years (range, 48-77 years). Six patients succumbed to mortality, and one continued to receive systemic chemotherapy at the last visit. The median survival time of the patients was 18.9 months (range, 10.0-27.2 months). Median time to progression after completion of the treatments was 8 months (range, 3-9 months). Two patients had progression of the primary tumor, and one patient had progression of the BM. The neurological status of three patients with BM who were identified during the staging work-up did not deteriorate as a consequence of WBRT. In conclusion, the present study has demonstrated that aggressive treatment of the primary tumor and oligo-BM in patients with EC may prolong the survival time. IntroductionEsophageal cancer (EC) is one of the most common tumors of the gastrointestinal system. The prognosis of EC patients is relatively poor, since the majority of patients are diagnosed at an advanced stage. The most common metastatic sites include the lungs, liver, and bones (1). The incidence of brain oligometastasis (oligo-BM) is extremely rare (1-3% incidence in clinical series) (2,3). The majority of patients with BM are diagnosed at an advanced clinical stage, and the majority of BMs tend to occur together with other organ metastases (2,4,5).Since brain imaging as part of a metastasis work-up is not routinely performed, detection of solitary BM at diagnosis is difficult. However, with the increased use of positron emission tomography (PET) at initial staging, along with advances in neuroimaging, the incidence of BM has gradually increased, as reported in the literature (6,7). Due to the rarity of BM in patients with EC, there is no standardized treatment for these patients. The survival time of patients with EC and metastasis to the brain ranges from 2 weeks to 25 months, depending on the extent of disease and the treatment modalities employed (7,8). Previously, it was demonstrated that patients with one to three BMs had improved survival rates with advanced treatment modalities (9). Therefore, an aggressive treatment approach may be effective for only a limited number of patients with good performance status and solitary metastasis. However, it is important to make balanced clinical decisions for treatment planning; specifically, how to identify patients with oligometastasis who would benefit from localized the...

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Section: Discussioncontrasting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Outcomes of aggressive treatment in esophageal cancer patients with synchronous solitary brain metastasis

Onal

Yıldırım

Güler

2017

Molecular and Clinical Oncology

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“…The median survival of patients with metastatic gastric cancer is no more than 1 year (13). In particular, the overall prognosis of patients with brain metastases from gastric cancer is extremely poor, with a median survival time of 2-4 months (4)(5)(6)14). In the absence of clear guidelines on therapy, each case requires individual analysis and a multidisciplinary approach.…”

Section: Discussionmentioning

confidence: 99%

A case report of gastric cancer with brain metastasis: Rare peripheral nervous system symptoms

et al. 2016

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Abstract. Gastric cancer with brain metastasis is rare. The present study reports a case of gastric cancer with isolated brain metastasis 1 year after gastrectomy. To the best of our knowledge, there have been no prior reports of solitary brain metastasis from gastric cancer with peripheral nervous system symptoms. A distal gastrectomy was performed on a 60-year-old male patient with gastric cancer in November 2012. Postoperative pathological analysis revealed a moderately differentiated adenocarcinoma with tumor invasion into the serosa and metastasis to one dissected lymph node. No abnormalities were found at follow-up examination. However, a tumor representing metastasis to the brain was recognized by a cranial enhanced magnetic resonance imaging examination 1 year after gastrectomy, which was performed when the patient exhibited numbness and thigmesthesia. The patient was administered 30 Gy of stereotactic radiotherapy, delivered in 5 fractions. The patient succumbed to disease 10 months subsequent to undergoing radiotherapy. This case report suggests that gastric cancer may re-present as brain metastasis with peripheral nervous system symptoms.

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“…Recurrence of GC often appears in the form of peritoneal dissemination, liver, lymph nodes and bone recurrence metastases are often seen (1). Central nervous system (CNS) metastasis from advanced gastric or gastro-esophageal (GE) junction cancer is extremely rare, occurring in 0.16-0.69% of patients (2)(3)(4)(5). CNS metastasis is often multiple and associated with metastasis to other organs and a resection is uncommon.…”

Section: Introductionmentioning

confidence: 99%

Gastric cancer with brain metastasis and the role of human epidermal growth factor 2 status

et al. 2018

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Abstract. Central nervous system (CNS) metastases from cancers of the gastrointestinal tract (GIT) are rare, and occur in 0.16-0.69% of patients with gastric or gastro-esophageal (GE) junction cancer. Overexpression of the human epidermal growth factor 2 (HER-2) is associated with poor prognosis in the absence of HER-2-targeted therapy, and with an increased incidence of CNS metastases in patients with breast cancer. The role of HER-2 overexpression in CNS metastases is not well known in gastric adenocarcinoma. The purpose of the present retrospective study was to assess the incidence of CNS metastases and to evaluate the associations between the CNS and HER-2 status in a series of consecutive patients with gastric or GE junction cancer. Between 2007 and 2013, 300 patients with gastric cancer (GC) or gastroesophageal junction, were admitted to Piacenza General Hospital, Italy. These cases were retrospectively analyzed to evaluate CNS metastases. The metastases were diagnosed with imaging techniques performed on symptomatic patients. Gastric histological samples of patients with CNS metastases were reviewed and tested for HER-2. A total of 7 of the 300 patients (2.33%) with GC were observed to have CNS metastases and 6 (85.71%) had HER-2 positive disease. These patients exhibited a poor prognosis with a median overall survival rate of 4.1 months (range, 2.1-6.6 months). These results suggested there may be CNS recurrence susceptibility in patients with HER-2 positive GC. To the best of our knowledge, this is the first report that associates CNS metastases and HER-2 status in gastric or GE junction cancer.

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Gastrointestinal Cancer And Brain Metastasis: A Rare And Ominous Sign

Cited by 36 publications

References 0 publications

Outcomes of aggressive treatment in esophageal cancer patients with synchronous solitary brain metastasis

Outcomes of aggressive treatment in esophageal cancer patients with synchronous solitary brain metastasis

A case report of gastric cancer with brain metastasis: Rare peripheral nervous system symptoms

Gastric cancer with brain metastasis and the role of human epidermal growth factor 2 status

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