title: Brain metastases from esophageal carcinoma: natural history, prognostic factors, and outcome.
abstract: BACKGROUND
  Brain metastases from esophageal carcinoma are extremely rare, and information regarding the natural history, results of treatment, and possible prognostic factors in these patients is limited.
  
  
  METHODS
  The records of 36 patients with brain metastases from esophageal carcinoma who were treated between 1986 and 2000 were reviewed. For brain metastases, 12 patients (33%) were treated with surgical resection followed by radiation therapy (S+RT), and the remaining 24 patients were treated with radiation therapy alone.
  
  
  RESULTS
  At the initial diagnosis of esophageal carcinoma, the median primary tumor length was 8 cm (range, 2-19 cm), and 26 of 32 available patients (81%) had clinical Stage III-IV tumors according to the International Union Against Cancer 1997 criteria. At time brain metastases appeared, lung metastases were not demonstrated in 25 of 36 patients (69%) who were assessed by chest computed tomography (CT) scans. The overall median survival for all patients was 3.9 months (range, 0.6-36.8 months), and the actuarial survival rates at 12 months and 24 months were 14% and 3%, respectively. In univariate analysis, treatment modality, Karnofsky performance status (KPS), and extracranial disease status each had a statistically significant impact on survival, and, in multivariate analysis, treatment modality and KPS were statistically significant prognostic factors for survival. Five patients (14%) survived more than 1 year, all of whom were treated with S+RT. These five patients had inactive extracranial disease and, four of five patients (80%) had a 90-100% KPS.
  
  
  CONCLUSIONS
  Brain metastases from esophageal carcinoma tended to occur in patients with a large primary tumors and/or disease in advanced clinical stages. With the appearance of brain metastases, an absence of lung metastasis frequently was observed on chest CT scans. The prognoses for these patients were generally poor, although selected patients may survive longer with intensive brain tumor treatment.
authors.affiliation: Department of Radiology, University of the Ryukyus School of Medicine, Okinawa, Japan. kogawa@med.u-ryukyu.ac.jp
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ogawa
authors.forename: Takafumi
authors.initials: T
authors.lastname: Toita
authors.forename: Hiroo
authors.initials: H
authors.lastname: Sueyama
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Fuwa
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Kakinohana
authors.forename: Minoru
authors.initials: M
authors.lastname: Kamata
authors.forename: Genki
authors.initials: G
authors.lastname: Adachi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Saito
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Yoshii
authors.forename: Sadayuki
authors.initials: S
authors.lastname: Murayama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000532:radiotherapy / Q000556:secondary*; D002277:Carcinoma / Q000532:radiotherapy / Q000556:secondary*; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome