title: Frequent brain metastasis after chemotherapy and surgery for advanced esophageal cancers.
abstract: OBJECTIVE
  Brain metastasis, rarely observed as a tumor recurrence after curative surgery for thoracic esophageal cancers (TEC), has been increasingly observed with improvement of the clinical outcome of TEC.
  
  
  METHODS
  Records of 254 TEC patients who developed recurrent cancers after curative surgery during 1984-2002 revealed 11 patients (4.3%) with symptomatic brain metastasis, which were classified as five without extra-cranial disease (Brain type) and six with other metastatic diseases (Systemic type).
  
  
  RESULTS
  Brain metastases were significantly associated with an advanced clinical stage and perioperative chemotherapy, which had been undergone by 73% of the brain metastasis patients, but only 23% for non-brain metastasis patients (p = 0.0008). Comparing to Systemic type, Brain type showed longer duration from esophagectomy to brain metastasis and tended to be more effective for perioperative chemotherapy. All Brain type but only two Systemic type brain metastases were removed by surgery. The average survival after brain metastasis was 17.7 months for the Brain type patients (two alive without tumor recurrence), but only 38.5 days for the Systemic type patients. The histological hallmark of Brain type metastasis was medullary tumor growth with mature tumor vessels, while Systemic type showed invasive tumor growth with naive capillaries.
  
  
  CONCLUSIONS
  Postoperative brain metastasis in TEC patients is not rare, especially in an advanced clinical stage following perioperative chemotherapy. Surgical removal of brain metastasis might be the most promising treatment unless tumor metastasis in other organs is evident.
authors.affiliation: Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Kawabata
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
authors.forename: Hidemitsu
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Ko
authors.initials: K
authors.lastname: Takachi
authors.forename: Isao
authors.initials: I
authors.lastname: Miyashiro
authors.forename: Yoshitane
authors.initials: Y
authors.lastname: Tsukamoto
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohigashi
authors.forename: Yo
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Kohei
authors.initials: K
authors.lastname: Murata
authors.forename: Shingo
authors.initials: S
authors.lastname: Ishiguro
authors.forename: Shingi
authors.initials: S
authors.lastname: Imaoka
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D016896:Treatment Outcome