Frequent brain metastasis after chemotherapy and surgery for advanced esophageal cancers.
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.
Kawabata
Ryohei
R
Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Japan.
Doki
Yuichiro
Y
Ishikawa
Osamu
O
Nakagawa
Hidemitsu
H
Takachi
Ko
K
Miyashiro
Isao
I
Tsukamoto
Yoshitane
Y
Ohigashi
Hiroaki
H
Sasaki
Yo
Y
Murata
Kohei
K
Ishiguro
Shingo
S
Imaoka
Shingi
S
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