title: Outcomes in patients with brain metastasis from esophageal carcinoma.
abstract: BACKGROUND
  Brain metastases from esophageal carcinoma have historically been rare and associated with poor prognosis. With improvements in systemic disease control, the incidence of brain metastases is expected to rise. To better inform management decisions, we sought to identify factors associated with survival in patients with brain metastasis from esophageal cancer.
  
  
  METHODS
  We retrospectively identified 49 patients with brain metastasis from stage I-IV primary esophageal cancer treated with surgery, radiation, or a combination of modalities at our tertiary referral center between 1998 and 2015. Medical records were reviewed to collect demographic and clinical information.
  
  
  RESULTS
  Median age at diagnosis of the primary esophageal cancer was 60 years. Forty-one (84%) patients were male and forty patients (82%) had adenocarcinoma. Median overall survival (MS) following esophageal cancer diagnosis was 24 months (range, 3-71 months), and median survival after the identification of brain metastases was 5 months (range, 1-52 months). On univariate analysis, only patients with poor Karnofsky performance status (KPS <70), recursive partitioning analysis (RPA) classification (III), or 3 or more brain metastases were found to have worsened survival after the diagnosis of brain metastases (all P<0.01). Factors not associated with survival were age, gender, histology (adenocarcinoma vs. other), palliative-intent treatment of the primary tumor, time to diagnosis of brain metastases from initial diagnosis, uncontrolled primary tumor at time of brain metastasis diagnosis, or extracranial metastases. On multivariate analysis (MVA, KPS excluded), patients with RPA class I (MS, 14.6 months) or II (MS, 5.0 months) disease had significantly improved overall survival compared to class III disease (MS, 1.6 months, P<0.01). Also on MVA, patients with 1 (MS, 10.7 months) or 2 (MS, 4.7 months) brain metastases had significantly improved overall survival compared to patients with 3 or more brain metastases (MS, 0.3 months, P<0.01). For the 36 patients with 1-2 brain metastases and KPS ≥70, MS was 11.1 months.
  
  
  CONCLUSIONS
  While the prognosis for esophageal cancer metastatic to brain remains poor overall, we found that patients with good performance status and limited number of brain lesions have superior survival. Aggressive management may further improve outcomes in these patients.
authors: Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA ;
authors: Nishi
authors: N
authors: Kothari
authors: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA ;
authors: Eric
authors: E
authors: Mellon
authors: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA ;
authors: Sarah E
authors: SE
authors: Hoffe
authors: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA ;
authors: Jessica
authors: J
authors: Frakes
authors: Department of Radiation Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA ;
authors: Ravi
authors: R
authors: Shridhar
authors: Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA ;
authors: Jose
authors: J
authors: Pimiento
authors: Department of Gastrointestinal Oncology, First Physicians Group, Sarasota, FL, USA ;
authors: Ken
authors: K
authors: Meredith
authors: Department of Neuro-oncology. H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
authors: Nam D
authors: ND
authors: Tran
authors: Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA ;
authors: Nadia
authors: N
authors: Saeed
authors: Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA ;
authors: Khaldoun
authors: K
authors: Almhanna
keywords: Brain metastasis; esophageal cancer; recursive partitioning analysis (RPA) score