Highlights
- •One of the first series to include data on histology.
- •8% of histologically confirmed suspected brain tumors are glioblastomas.
- •Radiotherapy is risk factor for developing BT (OR,7.71, 95%CI: 2.66–22.34).
- •Consider biopsy in oligometastatic setting.
Abstract
Background
Brain metastases after esophagectomy are rare. Moreover, a diagnostic uncertainty
remains as pathology is rarely obtained and radiological features can show similarities
to primary brain tumors. Our aim was to demonstrate the diagnostic uncertainty and
identify risk factors associated with brain tumors (BT) after esophagectomy with curative
intent.
Methods
All patients who underwent an esophagectomy with curative intent from 2000 to 2019
were reviewed. Diagnostics and characteristics of BT were analyzed. Multivariable
logistic and cox regression were performed to determine factors associated with development
of BT and survival, respectively.
Results
In total, 2131 patients underwent esophagectomy with curative intent, of which 72
patients (3.4%) developed BT. Pathological diagnosis was obtained in 26 patients (1.2%),
of which 2 patients were diagnosed with glioblastoma. On multivariate analysis, radiotherapy
(OR, 7.71; 95%CI: 2.66–22.34, p < 0.001) was associated with an increased risk of BT and early-stage tumors (OR,
0.29; 95%CI: 0.10–0.90, p = 0.004) with a decreased risk of BT. Median overall survival was 7.4 months (95%CI:
4.80–9.96). BT treated with curative intent (surgery or stereotactic radiation) had
a significantly better median overall survival (16 months; 95%CI: 11.3–20.7) compared
to those without (3.7 months; 95%CI: 0.9–6.6, p < 0.001)
Conclusions
Advanced stage tumors and radiotherapy seem related to the development of brain tumors
after esophagectomy with curative intent. However, an important diagnostic uncertainty
remains in these patients as pathological diagnosis is only obtained in a minority
of cases. Tissue confirmation can be useful to inform a patient-tailored multimodality
treatment strategy in select patient.
Keywords
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References
- Esophageal cancer: a Review of epidemiology, pathogenesis, staging workup and treatment modalities.World J Gastrointest Oncol. 2014; 6: 112https://doi.org/10.4251/wjgo.v6.i5.112
- Esophageal cancer recurrence patterns and implications for surveillance.J Thorac Oncol. 2013; 8: 1558-1562https://doi.org/10.1097/01.JTO.0000437420.38972.fb
- Oligometastases revisited.Nat Rev Clin Oncol. 2011; 8: 378-382https://doi.org/10.1038/nrclinonc.2011.44
- Characterisation and classification of oligometastatic disease: a European society for radiotherapy and oncology and European organisation for research and treatment of cancer consensus recommendation.Lancet Oncol. 2020; 21: e18-e28https://doi.org/10.1016/S1470-2045(19)30718-1
- Isolated local recurrence or solitary solid organ metastasis after esophagectomy for cancer is not the end of the road.Dis Esophagus. 2017; 30: 1-8https://doi.org/10.1111/dote.12508
- Resection of hepatic and pulmonary metastasis from metastatic esophageal and gastric cancer: a nationwide study.Dis Esophagus Off J Int Soc Dis Esophagus. 2019; 32: 1-8https://doi.org/10.1093/dote/doz034
- Outcomes in patients with brain metastasis from esophageal carcinoma.J Gastrointest Oncol. 2016; 7: 562-569https://doi.org/10.21037/jgo.2016.03.12
- Metastasis of esophageal carcinoma to the brain.Cancer. 2003; 98: 1925-1933https://doi.org/10.1002/cncr.11737
- Current trends for improving safety of stereotactic brain biopsies: advanced optical methods for vessel avoidance and tumor detection.Front Oncol. 2019; 9https://doi.org/10.3389/fonc.2019.00947
- Diagnostic yield and complication rate of stereotactic biopsies in precision medicine of gliomas.Front Neurol. 2022; 13: 1-11https://doi.org/10.3389/fneur.2022.822362
- Diagnostic value of peritumoral minimum apparent diffusion coefficient for differentiation of glioblastoma multiforme from solitary metastatic lesions.Am J Roentgenol. 2011; 196: 71-76https://doi.org/10.2214/AJR.10.4752
- Differentiation of primary central nervous system lymphoma from high-grade glioma and brain metastases using susceptibility-weighted imaging.Brain Behav. 2014; 4: 841-849https://doi.org/10.1002/brb3.288
- Distinction between high-grade gliomas and solitary metastases using peritumoral 3-T magnetic resonance spectroscopy, diffusion, and perfusion imagings.Neuroradiology. 2004; 46: 619-627https://doi.org/10.1007/s00234-004-1246-7
- Differentiation of primary central nervous system lymphoma from high-grade glioma and brain metastasis using arterial spin labeling and dynamic contrast-enhanced magnetic resonance imaging.Eur J Radiol. 2019; 112: 59-64https://doi.org/10.1016/j.ejrad.2019.01.008
- Brain metastases in patients with upper gastrointestinal cancer is associated with proximally located adenocarcinoma and lymph node metastases.Gastric Cancer. 2020; 23: 904-912https://doi.org/10.1007/s10120-020-01075-3
- Incidence and risk factors for isolated esophageal cancer recurrence to the brain.Ann Thorac Surg. 2020; 109: 329-336https://doi.org/10.1016/j.athoracsur.2019.09.028
- Brain metastases from esophageal cancer: a phenomenon of adjuvant therapy?.Ann Thorac Surg. 2006; 82https://doi.org/10.1016/j.athoracsur.2006.06.089
- Metastasis to and from the central nervous system - the “relatively protected site.Lancet Oncol. 2002; 3: 498-507https://doi.org/10.1016/S1470-2045(02)00819-7
- Incidence of brain metastases after trimodality therapy in patients with esophageal or gastroesophageal cancer: implications for screening and surveillance.Oncol. 2013; 85: 204-207https://doi.org/10.1159/000354736
- Multi-institutional analysis of recurrence and survival after neoadjuvant chemoradiotherapy of esophageal cancer: impact of histology on recurrence patterns and outcomes.Ann Surg. 2019; 269: 663-670https://doi.org/10.1097/SLA.0000000000002670
- Patterns and risk of recurrence in patients with esophageal cancer with a pathologic complete response after chemoradiotherapy followed by surgery.J Thorac Cardiovasc Surg. 2019; 157: 1249-1259.e5https://doi.org/10.1016/j.jtcvs.2018.09.136
- Predictive factors of recurrence in patients with pathological complete response after esophagectomy following neoadjuvant chemoradiotherapy for esophageal cancer: a multicenter study.Ann Surg Oncol. 2015; 22: 1357-1364https://doi.org/10.1245/s10434-015-4619-8
- Brain metastases from esophageal carcinoma: natural history, prognostic factors, and outcome.Cancer. 2002; 94: 759-764https://doi.org/10.1002/cncr.10271
- Patterns and timing of recurrence in esophageal squamous cell carcinoma patients treated with neoadjuvant chemoradiotherapy plus esophagectomy.BMC Cancer. 2021; 21: 1-11https://doi.org/10.1186/s12885-021-08918-x
- Recurrence after neoadjuvant chemoradiation and surgery for esophageal cancer: does the pattern of recurrence differ for patients with complete response and those with partial or no response?.J Thorac Cardiovasc Surg. 2009; 138: 1309-1317https://doi.org/10.1016/j.jtcvs.2009.07.069
- Normal tissue reactions to radiotherapy: towards tailoring treatment dose by genotype.Nat Rev Cancer. 2009; 9: 134-142https://doi.org/10.1038/nrc2587
- Effects of radiation on endothelial barrier and vascular integrity.Elsevier. 2021; https://doi.org/10.1016/B978-0-12-818561-2.00007-2
- The function of the vertebral veins and their role in the spread of Metasteses.pdf.Ann Surg. 1940; 112: 138-149
- Pathological complete response in patients with esophageal cancer after the trimodality approach: the association with baseline variables and survival—the University of Texas MD Anderson Cancer Center experience.Cancer. 2017; 123: 4106-4113https://doi.org/10.1002/cncr.30953
- Recurrence and survival after pathologic complete response to preoperative therapy followed by surgery for gastric or gastrooesophageal adenocarcinoma.Br J Cancer. 2011; 104: 1840-1847https://doi.org/10.1038/bjc.2011.175
- Heparanase-induced GEF-H1 signaling regulates the cytoskeletal dynamics of brain metastatic breast cancer cells.Mol Cancer Res. 2012; 10: 689-702https://doi.org/10.1158/1541-7786.MCR-11-0534
- Brain metastatic cancer cells release microRNA-181c-containing extracellular vesicles capable of destructing blood-brain barrier.Nat Commun. 2015; 6https://doi.org/10.1038/ncomms7716
- Tumour exosomal CEMIP protein promotes cancer cell colonization in brain metastasis.Nat Cell Biol. 2019; 21: 1403-1412https://doi.org/10.1038/s41556-019-0404-4
- Epidermal growth factor receptor mutations and brain metastasis in patients with nonadenocarcinoma of the lung.J Cancer Res Therapeut. 2016; 12: 318-322https://doi.org/10.4103/0973-1482.154024
- Erythroblastic oncogene B-2 status and intracranial metastatic disease in patients with gastrointestinal cancer: a systematic review.J Neuro Oncol. 2022; 160: 735-742https://doi.org/10.1007/s11060-022-04195-1
- Clinical outcome and molecular characterization of brain metastases from esophageal and gastric cancer: a systematic review.Med Oncol. 2017; 34: 1-10https://doi.org/10.1007/s12032-017-0919-0
- Brain metastases: pathobiology and emerging targeted therapies.Acta Neuropathol. 2012; 123: 205-222https://doi.org/10.1007/s00401-011-0933-9
- Brain metastases of gastro-oesophageal cancer: evaluation of molecules with relevance for targeted therapies.Anticancer Res. 2013; 33: 1065-1072
- Adult glioma incidence and survival by race or ethnicity in the United States from 2000 to 2014.JAMA Oncol. 2018; 4: 1254-1262https://doi.org/10.1001/jamaoncol.2018.1789
- Quality of life following stereotactic radiosurgery for single and multiple brain metastases.Neurosurgery. 2017; 81: 147-155https://doi.org/10.1093/neuros/nyw166
Article info
Publication history
Published online: April 21, 2023
Accepted:
April 21,
2023
Received in revised form:
April 16,
2023
Received:
March 17,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
