A metastatic brain tumor originating from esophageal carcinoma is very rare, accounting for only about 2% of all intracranial metastatic tumors.
In 16 patients, seven factors were analyzed including age, gender, Karnofsky performance score (KPS), time from diagnosis of esophageal cancer to irradiation, number of brain metastases, histology, and presence of extracerebral metastases.
Improved survival was significantly associated with KPS≥80 (p<0.001), the presence of one brain metastasis (p=0.007), and no extra-cerebral metastases (p=0.002). These factors were included in the final score. Factor scores were calculated by dividing 6-month survival rates by 10. Total survival scores represented the sums of factor scores and were 2, 7, 10, 19 or 24 points. Six-month survival rates by score were 0%, 0%, 0%, 67% and 100%, respectively. Two groups were formed, those of patients with 2-10 points and those with 19-24 points; 6-month survival was 0% and 88%, respectively (p<0.001).
This new score facilitates the selection of individual therapies for patients with brain metastases from esophageal cancer 2).
A patient who survived for 5 years after surgery and gamma knife treatment of a cerebellar metastasis from esophagogastric adenocarcinoma. The primary gastric cancer was treated by laparotomy with total gastrectomy, splenectomy, and D2 lymphadenectomy. It was diagnosed as a esophagogastric junction Siewert type II tumor, type 3, tub1-2, pT3 (SS), pN1, and stage IIB on histopathological examination of the surgical specimen. Five months postoperatively, a solitary cerebellar metastasis was identified and surgically removed, followed by 20 Gy administered by gamma knife stereotactic radiosurgery; the patient received no subsequent treatment such as chemotherapy. Five years after the primary surgery, there have been no recurrences and the patient has a good quality of life. There are very few case reports of long-term survival after surgical treatment of cerebellar metastases from esophagogastric junction cancer. We report our experience and review published case reports of surgical treatment of brain metastases from gastric cancer 3).
Fujii et al report three cases of metastatic brain tumor from esophageal carcinoma and present one interesting case. A 60-year-old man was referred to the hospital with aphasia, 3 years after surgery for esophageal carcinoma. Magnetic resonance imaging demonstrated a 7-cm mass lesion with a cystic component in the left temporal lobe. Tumor resection was performed and an Ommaya reservoir system was placed. Histological analysis indicated squamous cell carcinoma, and metastatic brain tumor from esophageal carcinoma was diagnosed. After surgery, the cystic component was collapsed by drainage through the Ommaya reservoir, and cyberknife therapy was performed as an adjunctive therapy. Regrowth of the cystic component and exacerbation of cognitive dysfunction were identified 2 months later, so aspiration of cyst fluid through the Ommaya reservoir was continued. However, the cystic component regrew 5 months after the operation, and the patient died 1 month later. Metastatic brain tumors from primary esophageal carcinoma often have a cystic component, which makes treatment difficult. Control of cyst growth by aspiration using the Ommaya reservoir is effective for improvement of functional prognosis in such patients 4).
A single institution retrospective analysis reviewed the experience with esophageal metastasis from 1987 to 2013. Thirty patients (36 SRS procedures) with a median age of 59 (37-86 years) underwent Gamma knife(®) SRS. The esophageal origin was adenocarcinoma in 26 patients (87%), squamous cell carcinoma in 3 patients (10%), and mixed neuroendocrine carcinoma in 1 patient (3%). Fifteen patients were treated for a single metastasis and 15 patients were treated for multiple metastases for a total of 87 tumors. The median tumor volume was 5.7 cm(3) (0.5-44 cm(3)) with a median marginal dose of 17 Gy (12-20 Gy). The median survival time from the diagnosis of brain metastasis was 8 months and the median survival from SRS was 4.2 months. This corresponded to a 6-month survival of 45% and a 12-month survival of 19% after SRS. A higher KPS at the time of procedure was associated with an increase in survival (p = 0.023). The local tumor control rate in this group was 92%. Four patients had repeat SRS for new metastatic deposits. One patient developed a new neurological deficit after SRS. SRS proved an effective means of providing local control for esophageal metastases to the brain. Concomitant systemic disease progression at the time of brain metastasis resulted in poor long-term survival 5).
A case of a patient with an unknown primary tumor who presented with a cerebral metastasis, without extra-neurological symptoms. He was subsequently diagnosed as an esophageal carcinoma 6).