Patients with brain metastases from gastrointestinal tract cancer treated with whole brain radiation therapy: Prognostic factors and survival

Bartelt, Susanne; Momm, Felix; Weißenberger, Christian; Lutterbach, Johannes

doi:10.3748/wjg.v10.i22.3345

Cited by 68 publications

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“…19 York et al 18 observed a greater incidence of primary tumors in the proximal stomach (67%) among patients with brain metastases. Similarly, Bartelt et al 5 also reported that 50% of gastric cancer patients who developed brain metastases had primary tumors in the gastric cardia. Concurrent systemic metastases were present in all patients with gastric cancer brain metastases and most commonly involved the bone (46%), liver (42%), and lung (29%).…”

Section: Gastric Cancermentioning

confidence: 99%

“…45 For CRC, the bDFI ranges from 22.6 to 27.6 months (Table 5), which is considerably longer than for other GI cancers (range, 5.6-30 months) 5,46 and lung cancer (average 4 months) but shorter than breast cancer (average 3 years). 45 Hammoud et al 45 investigated factors affecting bDFI for CRC and identified Dukes' stage and treatment status of extracerebral metastatic disease.…”

Section: Colorectal Cancermentioning

confidence: 99%

“…45 Several authors have reported that the primary location of the CRC tumor is an independent factor relating to incidence and survival following development of brain metastasis. 5,42,45 The distal colon, represented by the sigmoid, rectosigmoid junction, and rectum, is the primary tumor site in approximately 60% of all reported CRC brain metastases. 5,42,45 Hammoud et al 45 analyzed 150 CRC patients with brain metastasis and found that proximal colonic lesions, which are more often associated with liver metastasis, resulted in shorter survival compared with distal lesions (3 vs 6 months, P < .005).…”

Section: Colorectal Cancermentioning

confidence: 99%

“…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.…”

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Gastrointestinal cancer and brain metastasis

Klaassen

Meadows

et al. 2011

Cancer

170

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Metastatic brain tumors represent 20% to 40% of all intracranial neoplasms and are found most frequently in association with lung cancer (50%) and breast cancer (12%). Although brain metastases occur in <4% of all tumors of the gastrointestinal (GI) tract, the incidence of GI brain metastasis is rising in part due to more effective systemic treatments and prolonged survival of patients with GI cancer. Data were collected from 25 studies (11 colorectal, 7 esophageal, 2 gastric, 1 pancreatic, 1 intestinal, 3 all-inclusive GI tract cancer) and 13 case reports (4 pancreatic, 4 gallbladder, and 5 small bowel cancer). Brain metastases are found in 1% of colorectal cancer, 1.2% of esophageal cancer, 0.62% of gastric cancer, and 0.33% of pancreatic cancer cases. Surgical resection with whole brain radiation therapy (WBRT) has been associated with the longest median survival (38.4-262 weeks) compared with surgery alone (16.4-70.8 weeks), stereotactic radiosurgery (20-38 weeks), WBRT alone (7.2-16 weeks), or steroids (4-7 weeks). Survival in patients with brain metastasis from GI cancer was found to be diminished compared with metastases arising from the breast, lung, or kidney. Prolonged survival and improvement in clinical symptoms has been found to be best achieved with surgical resection and WBRT. Although early treatment has been linked to prolonged survival and improved quality of life, brain metastases represent a late manifestation of GI cancers and remain an ominous sign. Cancer 2011;117:3630-40. V C 2011 American Cancer Society.KEYWORDS: gastrointestinal cancer, brain metastasis, colorectal cancer, esophageal cancer, gastric cancer, gallbladder cancer, small bowel cancer, pancreatic cancer, whole brain radiation therapy, radiosurgery. 1 An estimated 25% to 35% of cancer cases are complicated by brain metastasis, the development of which is associated with a poor prognosis and an overall median survival of 4.2 months.2 Although brain metastases are frequently diagnosed in patients with lung cancer (48%), breast cancer (15%), testicular cancer (10% to 15%), and malignant melanoma (6% to 10%), 3,4 they rarely arise from gastrointestinal (GI) tract cancers. Bartelt et al 5 reported brain metastases in <4% of malignancies affecting the esophagus, stomach, colon, and rectum. However, the reported incidence of brain metastasis from GI cancers is rising due in part to an increased use of brain imaging modalities in these patients and prolonged survival associated with more effective systemic treatments. 6Gait disturbances, altered mental status or personality changes, and focal neurologic deficits are the most common clinical manifestations of metastatic brain disease, whereas memory loss and seizures are less common. 3,7 Brain metastases are a late manifestation of GI cancer 5 and associated with a median survival of 3.8 months compared with <7 months in similarly affected patients with primary breast or lung cancer. 3This report provides a comprehensive review of the incidence, prevalence, epidemiology, risk factors, ...

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Section: Gastric Cancermentioning

confidence: 99%

Section: Colorectal Cancermentioning

confidence: 99%

Section: Colorectal Cancermentioning

confidence: 99%

mentioning

confidence: 99%

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Gastrointestinal cancer and brain metastasis

Klaassen

Meadows

et al. 2011

Cancer

170

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“…However, BM from esophageal carcinoma (BMEC) is extremely rare. According to Bartelt and colleagues, the incidence of BM from gastrointestinal tumors, including esophageal, gastric, and colorectal carcinomas, is less than 4% [4] . As the incidence of esophageal cancer has been reported to have gradually increased in the United States [5] , the number of reports on BMEC has also increased in recent years [6] .…”

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Incidence and treatment of brain metastasis in patients with esophageal carcinoma

Feng¹,

Zhang²,

Zheng³

et al. 2015

WJG

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Brain metastasis from esophageal carcinoma (BMEC) is very rare, but its incidence has increased in the United States, Japan, China and other counties. Reports on BMEC have largely been focused on examining whether adjuvant therapy for esophageal cancer influences the survival duration of BMEC patients and on the imaging characteristics of BMEC determined using new medical equipment. The difference between different pathological types of esophageal cancer, especially adenocarcinoma and squamous cell carcinoma, is one important factor used to assess the influence of BMEC. Adjuvant therapy, including radiotherapy and chemotherapy, for esophageal cancer with different characteristics in different countries may affect BMEC treatment outcomes. The degree of popularization of advanced medical equipment is a major concern related to the prevalence of BMEC. Furthermore, targeted BMEC treatment is under development in developed countries. In this article, we reviewed the debate surrounding BMEC and analyzed BMEC studies from different perspectives.

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Impact of prior cancer history on survival in brain malignancy: A propensity score‐adjusted, population‐based study

Ebad Ur Rehman,

Faraz,

Cheema

et al. 2024

Cancer Reports

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BackgroundIndividuals with a Prior Cancer History (PCH) are often excluded from clinical trials. However, a growing body of evidence suggests that prior cancer history does not present adverse outcomes on cancer patients. The evidence on the survival of brain cancer patients in this regard remains widely unknown.MethodsWe conducted a retrospective cohort study to estimate the prevalence and impact of prior cancer on survival of patients diagnosed with brain cancer. Data of patients who were diagnosed with brain cancer as their first or second primary malignancy between 2000 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity Score Matching (PSM) was used to ensure comparable baseline characteristics among the patients. Survival analysis was conducted using the Kaplan–Meier method, as well as multivariate Cox proportional hazard and multivariate competing risk models.ResultsOut of 42 726 patients, 1189 (2.78%) had PCH. Genitourinary (40.4%), Breast (13.6%), Hematologic and Lymphatic (11.4%), and Gastrointestinal malignancies (11.3%) were the most common types of prior cancer. PCH served as a significant risk factor for Overall Survival (OS) (Adjusted Hazard Ratio [AHR] 1.26; 95% CI [1.15–1.39]; p < .001) but did not have a statistically significant impact on Brain Cancer‐Specific Survival (BCSS) (AHR 0.97; 95% CI [0.88–1.07]; p = .54). Glioblastoma exhibited the most substantial and statistically significant impact on survival as compared to other histological types. Of all the organs systems, only prior Gastrointestinal and Hematologic and Lymphatic malignancies had a statistically significant impact on OS of patients.ConclusionOur findings indicate that PCH does not exert a substantial impact on the survival of brain cancer patients, except in cases involving gastrointestinal or hematologic and lymphatic PCH, or when the brain cancer is glioblastoma.

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Patients with brain metastases from gastrointestinal tract cancer treated with whole brain radiation therapy: Prognostic factors and survival

Abstract: Brain metastases occur late in the course of gastrointestinal tumors. Pretherapeutic variables like KPS and the number of brain metastases have a profound influence on treatment outcome.

Cited by 68 publications

References 40 publications

Gastrointestinal cancer and brain metastasis

Gastrointestinal cancer and brain metastasis

Incidence and treatment of brain metastasis in patients with esophageal carcinoma

Impact of prior cancer history on survival in brain malignancy: A propensity score‐adjusted, population‐based study

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