Incidence of Brain Metastases after Trimodality Therapy in Patients with Esophageal or Gastroesophageal Cancer: Implications for Screening and Surveillance

Abstract

Background: It is unclear whether patients undergoing trimodality therapy (TMT) should be screened or surveyed for brain metastases. Methods: We retrospectively analyzed esophageal cancer (EC) patients who underwent TMT between the years 2000 and 2010. All were systematically staged and surveyed but none had screening or surveillance brain imaging. Results: The median follow-up time for 518 patients was 29.3 months (range 1-149.2); all patients had adenocarcinoma of the esophagus. Of 188 (36.3%) patients who developed distant metastases, 20 (10.6% of 188 patients or 3.9% of 518 patients) had brain metastases. A higher baseline clinical stage (stage III or IVa) was associated with brain metastases. Most (90%) patients with brain metastases were diagnosed within 24 months of surgery. Sixteen patients had central nervous system symptoms at diagnosis. Twelve (60%) patients had solitary metastasis and 8 (40%) patients had multiple metastases. Although 17 patients received therapy for brain metastases, the median overall survival time of 20 patients was only 10.5 months (95% CI 6.6-14.0). Conclusion: After TMT, 3.9% of EC patients developed brain metastases and their prognosis was poor. Our data suggest that screening and/or surveillance for brain metastases in the EC population undergoing TMT is not warranted.

Incidence and treatment of brain metastasis in patients with esophageal carcinoma

“…In their study, they included 403 patients with esophageal cancer who received only Clinical characteristic Japan [19] United States [20] China [18] n = 36 n = 27 n = 31 [23] , 518 esophageal adenocarcinoma patients receiving trimodal therapy were retrospectively analyzed. In that study, distant metastasis was found in 188 cases (36.3%), including 20 cases of BM (3.9%).…”

“…BM typically occurs after treatment [4,6,7,18,[20][21][22][23] , although concurrent BM and EC have been rarely reported (less than 10 cases in the literature). In some individual case reports [7,[24][25][26] , especially in misdiagnosed cases [7,25,26] , BM was found before the primary lesion of the esophagus was detected.…”

“…In those cases, BM was often misdiagnosed as meningitis, a pituitary tumor, or glioma. BM predominantly occurs after treatment [4,6,7,18,[20][21][22][23] based on the results of BM occurrence at 5 [27] , 6.7 [17] , 8.4 [28] , or 10 mo [29] after treatment, ranging from 4 to 57 mo. Clinical staging and adjuvant therapy are considered to be associated with BMEC, but the factors influencing the interval from treatment to BMEC occurrence have not been clarified.…”

“…In general, the BM treatment approaches include simple surgery, chemotherapy, RT, or a combination of two or all of these approaches. There are three types of surgery for BM: punch partial excisional biopsy [26] , subtotal tumor removal [31] , and single lesion resection [21][22][23] . Combined 5-fluorouracil (5-FU) and platinum is the most commonly used chemotherapy for BM.…”

“…Combined 5-fluorouracil (5-FU) and platinum is the most commonly used chemotherapy for BM. Other drugs such as doxorubicin, irinotecan, and cetuximab are also used [23] . RT includes WBRT, partial brain irradiation combined or not combined with WBRT, conformal RT, intensity-modulated RT, and stereotactic body RT [23] .…”