Metastasis of esophageal carcinoma to the brain

Abstract

BACKGROUND Esophageal carcinoma rarely metastasizes to the brain. The objectives of the current study were to assess the frequency of brain metastasis from an esophageal primary tumor, to determine correlates of survival, and to describe treatment modalities and their outcomes. METHODS Between June, 1993 and July, 2001, 1588 patients with a primary esophageal carcinoma registered at The University of Texas M. D. Anderson Cancer Center; of those, 27 patients (1.7%) had a diagnosis of brain metastasis. The authors collected demographic and clinical data and performed a statistical analysis. RESULTS The median age at the time patients were diagnosed with brain metastasis was 62 years. Tumor histologies were adenocarcinoma in 22 patients (82%), unclassified carcinoma in 3 patients (11%), and squamous cell carcinoma in 2 patients (7%). Twenty patients (74%) experienced symptoms related to the brain metastasis. The metastases were treated with whole‐brain radiation therapy (WBRT) alone in 15 patients (56%), and 10 patients (37%) underwent surgical resection, 4 of whom (15%) also received WBRT. Two patients (7%) underwent stereotactic radiosurgery. The median survival for the entire cohort after diagnosis of the primary tumor was 12.6 months (95% confidence interval [CI], 2.17–22.5 months), and the median survival after the diagnosis of brain metastasis was 3.8 months (95% CI, 1.1–6.5 months). The longest median survival observed after the diagnosis of brain metastasis (9.6 months) occurred in patients with a single brain lesion who underwent resection and received WBRT. There was a trend toward worse survival in patients with liver metastases and patients in recursive partitioning analysis (RPA) Class II–III versus RPA Class I (P = 0.10 for both; multivariate Cox proportional hazards model analysis). CONCLUSIONS Approximately 2% of patients with esophageal carcinoma had a diagnosis of brain metastasis. Improved outcome was associated with single brain lesions in patients who underwent surgery and received WBRT. Known liver metastasis and higher RPA scores were associated with a poorer survival trend. Cancer 2003. © 2003 American Cancer Society.

Gastrointestinal cancer and brain metastasis

“…1 Fifty percent of newly diagnosed patients have unresectable or metastatic disease at the time of diagnosis, typically to the lungs, liver, and adrenal glands. 8,[10][11][12] Brain metastasis from esophageal cancer remains a rare occurrence with approximately 100 clinical cases reported in the world literature (Table 1). Metastatic spread to the brain likely occurs via Batson's vertebral venous plexus, which provides communication between the esophagus and central nervous system (CNS).…”

“…Metastatic spread to the brain likely occurs via Batson's vertebral venous plexus, which provides communication between the esophagus and central nervous system (CNS). 5,8,10 Clinical cohort studies have identified brain metastases in up to 2.1% of esophageal cancer cases and in 1% to 5% of patients in postmortem studies. [13][14][15][16] Weinberg et al 8 reported on 1588 patients treated at The MD Anderson Cancer Center between 1993 and 2001, and identified only 27 patients (1.7%) with esophageal cancer brain metastases, 19 (70%) of whom had concurrent systemic disease.…”

“…5,8,10 Clinical cohort studies have identified brain metastases in up to 2.1% of esophageal cancer cases and in 1% to 5% of patients in postmortem studies. [13][14][15][16] Weinberg et al 8 reported on 1588 patients treated at The MD Anderson Cancer Center between 1993 and 2001, and identified only 27 patients (1.7%) with esophageal cancer brain metastases, 19 (70%) of whom had concurrent systemic disease. Available data would suggest that the brain diseasefree interval (bDFI) for esophageal cancer, defined as the interval between diagnosis of the primary tumor and discovery of brain metastasis, ranges from 5.6 to 12.3 months (Table 1).…”

“…Risk factors for the development of brain metastases in patients with esophageal cancer include advanced stage and size of the primary tumor. 8,10,14 Ogawa et al 10 reported that 26 of 32 (81%) esophageal cancer patients with brain metastases had stage III or stage IV esophageal cancer, whereas Weinberg et al 8 noted that 19 of 27 (70%) such patients had stage IV disease. In a retrospective analysis of 496 patients with primary esophageal tumors, Gabrielsen et al 14 studied the correlation between primary esophageal tumor size and the presence of brain metastasis and reported a mean tumor size of >8.63 cm (standard deviation [SD] AE 2.79 cm) among 15 patients diagnosed with brain metastasis compared with <5.12 cm (SD AE 2.56 cm) in those with no metastases (P < .001).…”

“…During the same period, a cohort of 803 patients receiving treatment for metastatic brain tumors were surveyed, and it was noted that 17 (2.1%) patients among this group had primary esophageal cancer. 11 In Western series, the majority of brain metastases are found among patients with esophageal adenocarcinoma, 8,14 whereas in Japan they are more common among patients with esophageal squamous cell carcinoma 10,11 (Table 2). These results likely reflect the higher incidence of adenocarcinoma in the United States and squamous cell carcinoma in Asia and suggest tumor histology is not an independent risk factor for esophageal brain metastasis.…”