Incidence of brain metastases after trimodality therapy in patients with esophageal or gastroesophageal cancer: implications for screening and surveillance.
BACKGROUND
It is unclear whether patients undergoing trimodality therapy (TMT) should be screened or surveyed for brain metastases.


METHODS
We retrospectively analyzed esophageal cancer (EC) patients who underwent TMT between the years 2000 and 2010. All were systematically staged and surveyed but none had screening or surveillance brain imaging.


RESULTS
The median follow-up time for 518 patients was 29.3 months (range 1-149.2); all patients had adenocarcinoma of the esophagus. Of 188 (36.3%) patients who developed distant metastases, 20 (10.6% of 188 patients or 3.9% of 518 patients) had brain metastases. A higher baseline clinical stage (stage III or IVa) was associated with brain metastases. Most (90%) patients with brain metastases were diagnosed within 24 months of surgery. Sixteen patients had central nervous system symptoms at diagnosis. Twelve (60%) patients had solitary metastasis and 8 (40%) patients had multiple metastases. Although 17 patients received therapy for brain metastases, the median overall survival time of 20 patients was only 10.5 months (95% CI 6.6-14.0).


CONCLUSIONS
After TMT, 3.9% of EC patients developed brain metastases and their prognosis was poor. Our data suggest that screening and/or surveillance for brain metastases in the EC population undergoing TMT is not warranted.
Department of GI Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Tex., USA.
Roopma
R
Wadhwa
Takashi
T
Taketa
Arlene M
AM
Correa
Kazuki
K
Sudo
Maria-Claudia
MC
Campagna
Mariela A
MA
Blum
Ritsuko
R
Komaki
Heath
H
Skinner
Jeffrey H
JH
Lee
Manoop S
MS
Bhutani
Brian
B
Weston
Dipen M
DM
Maru
David C
DC
Rice
Stephen
S
Swisher
Wayne L
WL
Hofstetter
Jaffer A
JA
Ajani
D000230:Adenocarcinoma / Q000556:secondary* / Q000628:therapy; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000453:epidemiology / Q000556:secondary*; D001952:Bridged-Ring Compounds / Q000627:therapeutic use; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D055088:Early Detection of Cancer; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017671:Platinum Compounds / Q000627:therapeutic use; D012189:Retrospective Studies; D015996:Survival Rate; D043823:Taxoids / Q000627:therapeutic use; D055815:Young Adult
D001952:Bridged-Ring Compounds; D017671:Platinum Compounds; D043823:Taxoids; C080625:taxane; D005472:Fluorouracil