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

Abstract

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...

A nomogram to predict long-time survival for patients with M1 diseases of esophageal cancer

“…All but one patient received definitive chemoradiothearapy and whole-brain radiotherapy. The median survival time was 18.9 months (range: 10.0-27.2 months) 12 . Welch G et al found that for esophageal cancer patients with brain metastasis, OS was superior for those initially had surgical resection with the 1-year OS as high as 67% 11 .…”

Oligometastatic Adenocarcinoma of the Esophagus: Current Understanding, Diagnosis, and Therapeutic Strategies

“…Additional small series, including Hiyoshi et al and Huddy et al, demonstrated similar findings [43,47]. Onal et al's investigation of outcomes in esophageal cancer patients with isolated synchronous brain oligometastasis included five patients with adenocarcinoma out of the seven included for analysis [48]. Patients underwent definitive chemoradiotherapy of the primary tumor and locally ablative treatment of the brain metastasis, with a median time to progression of 8 months and median survival of 18.9 months.…”

Detection and management of oligometastatic disease in oesophageal cancer and identification of prognostic factors: A systematic review

“…Two studies assessed survival in oesophageal cancer patients presenting with synchronous oligometastasis[36,37] (Supplementary Tables 4 and 5). Onal et al[36] assessed the impact of an aggressive treatment approach of both primary tumour and solitary brain metastasis. Patients underwent definitive CRT of the primary tumour locally ablative treatment of the brain metastasis, consisting of radiotherapy, surgery or radiosurgery.…”

“…Hiyoshi et al[34] did not show any benefit in the resection of lesions in the brain or bone. In contrast with this, Onal et al[36] suggested an improvement in survival outcome in patients with oligometastatic brain metastasis when treated with an aggressive approach of both the primary tumour and the metastatic lesion.…”

“…The results of the FLOT5 study is still awaiting to be published, assessing the effect of chemotherapy alone versus chemotherapy followed by surgical resection on survival and quality of life in patients with limited metastatic adenocarcinoma of the stomach or oesophagogastric junction. Only two papers assessed the presence of synchronous oligometastasis in patients with oesophageal cancer[36,37]. Hence, no comparison in the difference of between the presence of synchronous or metachronous oligometastatic disease could be made regarding survival outcomes.…”