Brain Metastases from Esophageal Squamous Cell Carcinoma: Clinical Characteristics and Prognosis

Abstract

PurposeDue to the low incidence of intracranial disease among patients with esophageal cancer (EC), optimal management for these patients has not been established. The aim of this real-world study is to describe the clinical characteristics, treatment approaches, and outcomes for esophageal squamous cell carcinoma (ESCC) patients with brain metastases in order to provide a reference for treatment and associated outcomes of these patients.MethodsPatients with ESCC treated at the Fourth Hospital of Hebei Medical University between January 1, 2009 and May 31,2020 were identified in an institutional tumor registry. Patients with brain metastases were included for further analysis and categorized by treatment received. Survival was evaluated by the Kaplan-Meier method and Cox proportional hazards models.ResultsAmong 19,225 patients with ESCC, 66 (0.34%) were diagnosed with brain metastases. Five patients were treated with surgery, 40 patients were treated with radiotherapy, 10 with systemic therapy alone, and 15 with supportive care alone. The median follow-up time was 7.3 months (95% CI 7.4-11.4). At last follow-up, 59 patients are deceased and 7 patients are alive. Median overall survival (OS) from time of brain metastases diagnosis was 7.6 months (95% CI 5.3-9.9) for all cases. For patients who received locoregional treatment, median OS was 10.9 months (95% CI 7.4-14.3), and survival rates at 6 and 12 months were 75.6% and 37.2%, respectively. For patients without locoregional treatment, median OS was 3.0 months (95% CI 2.5-3.5), and survival rates at 6 and 12 months were 32% and 24%, respectively. OS was significantly improved for patients who received locoregional treatment compared to those treated with systematic treatment alone or supportive care (HR: 2.761, 95% CI 1.509-5.053, P=0.001). The median OS of patients with diagnosis-specific graded prognostic assessment (DS-GPA) score 0-2 was 6.4 months, compared to median OS of 12.3 months for patients with DS-GPA >2 (HR: 0.507, 95% CI 0.283-0.911).ConclusionBrain metastases are rare in patients with ESCC. DS-GPA score maybe a useful prognostic tool for ESCC patients with brain metastases. Receipt of locoregional treatment including brain surgery and radiotherapy was associated with improved survival.

Could intracranial tumor volume predict prognosis of patients with brain metastases from esophageal carcinoma?

“…If intracranial tumor volume might not be an important prognostic factor, we should focus on ameliorating the GPA score of the patients and execute active locoregional treatment based on our previous research. 7 In previous studies for patients with nongastrointestinal cancer, the optimal threshold of CITV for prognostic difference was often between 2 and 4 cm 3 , 10-15 while in the study by Joshi et al 9 the optimal threshold was 12 cm 3 . In our study, the optimal threshold was 6.65 cm 3 , thus gastrointestinal cancer might have lager threshold than that of other cancers, and different thresholds might reflect different biological characteristics in various tumors.…”

“…Multicenter data collection should be recommended to explore further the relationship between intracranial tumor volume and prognosis of these patients. If intracranial tumor volume might not be an important prognostic factor, we should focus on ameliorating the GPA score of the patients and execute active locoregional treatment based on our previous research 7 …”

“…Esophageal carcinoma (EC) is one of the most common malignancies in the world, and these patients often have poor prognosis. Brain metastasis is rare in patients with EC 1–7 . Prognosis for patients with EC and brain metastases is much poorer, with reported median overall survival (OS) of 6 months approximately 2–5,7 .…”

“…In clinical practice, common treatment methods include surgery, radiotherapy, and systemic therapy. Our previous study showed that the median OS was 7.6 months for 66 patients with esophageal squamous cell carcinoma (ESCC) 7 . Receipt of locoregional treatment, including brain surgery and radiotherapy, was associated with improved survival.…”

“…Brain metastasis is rare in patients with EC. 1 , 2 , 3 , 4 , 5 , 6 , 7 Prognosis for patients with EC and brain metastases is much poorer, with reported median overall survival (OS) of 6 months approximately. 2 , 3 , 4 , 5 , 7 In clinical practice, common treatment methods include surgery, radiotherapy, and systemic therapy.…”