Treatment strategy for brain metastases from esophageal cancer

Abstract

Background: This study aimed to examine the treatment outcomes of patients with brain metastases from esophageal cancer. Brain metastases from esophageal cancer are rare and have a poorer prognosis than brain metastases from lung and breast cancer. Methods: This study included patients who were diagnosed with and treated for esophageal cancer in our department and subsequently developed brain metastases between April 2010 and December 2014. We examined the differences in survival in patients based on receiving chemotherapy. Results: In total, 8 patients (7 men and 1 woman) with a mean age of 65 years (range 51–73) were included. Seven presented with neurologic symptoms. Two were diagnosed via computed tomography (CT), 5 via magnetic resonance imaging, and 1 via positron emission tomography/CT. They were treated using whole-brain irradiation or with a gamma knife. In 5 patients, chemotherapy was administered after treatment of the brain metastases. The mean survival from the start of treatment was 358 days (range 31–1196). Conclusion: The relatively successful local control of brain metastases in these patients indicates that long-term survival may be attainable via concomitant chemotherapy.

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

“…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. The median age of the whole cohort was 59.5 years, which is similar to previous reports on ESCC and EAC (with the median age ranging from 60.7 to 65 years) (6,12). The primary tumor was mostly located in the mid-thoracic esophagus (14/18, 77.8%).…”

“…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.…”

“…They found that the median OS of patients who received brain radiotherapy was significantly higher than that of patients who did not receive brain radiotherapy (7.13 vs. 3.4 months). Similarly, Domeki et al (6) reported eight patients with BM from EC and demonstrated that brain radiotherapy could provide good local control, improve neurological symptoms, and achieve curative effect if the extracranial disease was wellcontrolled. These studies reveal that brain radiotherapy is still an indispensable treatment method and could improve the survival of patients with BM from EC, especially before effective systemic drugs are available to control intracranial metastases.…”

“…The primary tumor was mostly located in the mid-thoracic esophagus (14/18, 77.8%). It has been reported that the rate of solitary BM from ESCC is 50-78.1% (6,9). In the current study, nine cases developed solitary BM, accounting for 50% in the reported range for BM of ESCC, suggesting no association between the number of BM and the pathological subtype of EC.…”

“…Brain radiotherapy can reduce 80-90% of the neurological symptoms caused by BM (4,5). Domeki et al (6) have shown that seven patients who reported with EC and BM received relief from their neurological symptoms after Gamma Knife or whole-brain radiotherapy (WBRT). The median overall survival (OS) was only 3.3-3.9 months for patients with EC and BM, which is worse than that for lung cancer or breast cancer.…”