- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University School of Medicine, 1-1-1, Honjo, Kumamoto 860 - 8556, Japan
- Department of Neurosurgery, Saiseikai Kumamoto Hospital, 1-3-5, Chikami, Kumamoto 861- 4193, Japan
Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University School of Medicine, 1-1-1, Honjo, Kumamoto 860 - 8556, Japan
DOI:10.4103/2152-7806.141468Copyright: © 2014 Yamamoto T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Yamamoto T, Kuroda J, Takezaki T, Shinojima N, Hide T, Makino K, Nakamura H, Yano S, Nishi T, Kuratsu J. Characteristics of brain metastases from esophageal carcinoma. Surg Neurol Int 22-Sep-2014;5:137
How to cite this URL: Yamamoto T, Kuroda J, Takezaki T, Shinojima N, Hide T, Makino K, Nakamura H, Yano S, Nishi T, Kuratsu J. Characteristics of brain metastases from esophageal carcinoma. Surg Neurol Int 22-Sep-2014;5:137. Available from: http://sni.wpengine.com/surgicalint_articles/characteristics-of-brain-metastases-from-esophageal-carcinoma/
Background:Esophageal carcinoma (EC) is a major malignancy with a poor prognosis. Although esophageal cancers rarely metastasize to the brain, the number of patients diagnosed with brain metastases (BM) from EC is steadily increasing. Therefore, the risk factors for BM from EC should be known. Here we reviewed our experiences and the previous literature regarding BM from EC.
Methods:Between 2000 and 2013, we retrospectively reviewed the clinical features and neurological findings of 19 patients diagnosed with and treated for BM from EC to determine the clinical risk factors and features.
Results:In all patients, the lesions were partially or completed located in the thoracic esophagus, and the average size of the EC lesion at diagnosis was 5.8 ± 2.9 cm, which was smaller than the previously reported size of EC lesions accompanied by BM. Patients without lung metastases were more common than those with lung metastases. The lesions in the 13 patients included squamous cell carcinoma (SqCC) in 9 (69.2%) and small cell carcinoma (SmCC) in 3 (23.0%). Six patients were not examined. Although there was no trend toward a higher incidence of BM in patients with adenocarcinoma and SqCC, this trend was observed in patients with SmCC. Excluding a single patient with SmCC, all patients had beyond stage III disease at EC diagnosis.
Conclusions:Our study suggests that BM can occur in patients with EC lesions smaller than those previously reported; moreover, SmCC may be a risk factor for BM from EC.
Keywords: Adenocarcinoma, brain metastases, esophageal carcinoma, small cell carcinoma, squamous cell carcinoma
Esophageal carcinoma (EC) is a major malignancy with a poor prognosis and a 5-year survival rate of 23%.[
Between 2000 and 2013, 19 patients with BM from EC were diagnosed and treated at Kumamoto University Hospital and Saiseikai Kumamoto Hospital in Kumamoto City in southern Japan. All patients with BM were diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI). To determine the clinical risk factors and features of BM in patients with EC, we retrospectively reviewed their clinical features and neurological findings. Specifically, the following information was collected: Patient age and sex, time from EC diagnosis to BM occurrence, EC size, EC stage at diagnosis, treatment, EC location, BM location and imaging characteristics, neurological symptoms, histology, concurrent metastatic sites, and survival data. Time from EC diagnosis to BM occurrence was actuarially calculated using the Kaplan-Meier method. A probability level of 0.05 was set for statistical significance. Statistical analysis was performed using StatMate III, Version 3.19 (ATMS, Tokyo, Japan).
The average EC size at diagnosis was 5.8 ± 2.9 cm in the 15 patients whose size data were collected. EC location ranged from cervical esophagus (Ce) to abdominal esophagus (Ae). The data on EC location were collected in 17 patients. EC that was partly or completely located in the middle thoracic esophagus (Mt) was the most common (12/17 patients), and the lesions were partly or completely located in the thoracic esophagus (Te) in all patients. In the 15 patients whose staging data were collected, EC at diagnosis was stage IV in 10 patients, stage III in 4 patients, and stage II in 1 patient; therefore, excluding 1 patient with small cell carcinoma (SmCC), all patients had beyond stage III disease.
The clinical data and characteristics of BM in the 19 patients are summarized in
According to the comprehensive registry of EC in Japan, EC progresses in 2% males and 0.4% females.[
Although it is well known that EC rarely metastasizes to the brain, the number of patients diagnosed with BM from EC is increasing. Metastases are thought to occur via local invasion and hematogenous spread,[
In the study by Ogawa et al., the primary lesions were stage III or stage IV in 81% patients with BM.[
This study was limited by the fact that the risk factors for metastases were not statistically evaluated because no data was available for EC patients without BM. However, our retrospective review of patients with BM from EC revealed valuable findings.
Our study suggests that BM can occur in association with EC lesions that are smaller than those previously reported and that SmCC may be a risk factor for BM from EC. The findings from this study and previous studies suggest that BM should be considered in patients with beyond stage III EC lesions, those with EC lesions located partly or completely in the thoracic esophagus, which cannot be removed by surgery, and those with local invasion or lymph node metastasis,[
The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. This work has no specific funding and financial disclosure.
1. Agrawal R, Shukla P, Shukla V, Chauhan A. Brain metastasis from esophageal carcinoma. J Cancer Res Ther. 2009. 5: 137-9
2. Almasi S, Bashashati M, Rezaei N, Markazi-Moghaddam N. Brain metastasis from esophageal carcinoma. Neurol India. 2004. 52: 492-3
3. Anderson LL, Lad TE. Autopsy findings in squamous-cell carcinoma of the esophagus. Cancer. 1982. 50: 1587-90
4. Appelqvist P. Carcinoma of the oesophagus and gastric cardia at autopsy in Finland. Ann Clin Res. 1975. 7: 334-40
5. Batson OV. The function of the vertebral veins and their role in the spread of metastases. Ann Surg. 1940. 112: 138-49
6. Bosch A, Frias Z, Caldwell WL, Jaeschke WH. Autopsy findings in carcinoma of the esophagus. Acta Radiol Oncol Radiat Phys Biol. 1979. 18: 103-12
7. Chan KW, Chan EY, Chan CW. Carcinoma of the esophagus. An autopsy study of 231 cases. Pathology. 1986. 18: 400-5
8. Chalasani N, Wo JM, Waring JP. Racial differences in the histology, location, and risk factors of esophageal cancer. J Clin Gastroenterol. 1998. 26: 11-3
9. Gabrielsen TO, Eldevik OP, Orringer MB, Marshall BL. Esophageal carcinoma metastatic to the brain: Clinical value and cost-effectiveness of routine enhanced head CT before esophagectomy. AJNR Am J Neuroradiol. 1995. 16: 1915-21
10. Go PH, Klaassen Z, Meadows MC, Chamberlain RS. Gastrointestinal cancer and brain metastasis: A rare and ominous sign. Cancer. 2011. 117: 3630-40
11. Ide H, Ozawa S, Matsubara H. Comprehensive registry of esophageal cancer in Japan. Esophagus. 2000. 6: 27-47
12. Kaneko T, Hirao M, Shimada M, Takayama T, Iwazawa T, Murata K. Postoperative brain metastasis from esophageal carcinomas: Report of 4 cases (in Japanese). Kyobu Geka. 1991. 44: 1013-7
13. Kanemoto A, Hashimoto T, Harada H, Asakura H, Ogawa H, Furutani K. Occurrence and clinical features of brain metastasis after chemoradiotherapy for esophageal carcinoma. J Radiat Res. 2011. 52: 509-15
14. Mandard AM, Chasle J, Marnay J, Villedieu B, Bianco C, Roussel A. Autopsy findings in III cases of esophageal cancer. Cancer. 1981. 48: 329-35
15. Nakagawa H, Miyawaki Y, Fujita T, Kubo S, Tokiyoshi K, Tsuruzono K. Surgical treatment of brain metastases of lung cancer: Retrospective analysis of 89 cases. J Neurol Neurosurg Psychiatry. 1994. 57: 950-6
16. Ogawa K, Toita T, Sueyama H, Fuwa N, Kakinohana Y, Kamata M. Brain metastases from esophageal carcinoma: Natural history, prognostic factors, and outcome. Cancer. 2002. 94: 759-64
17. Quint LE, Hepburn LM, Francis IR, Whyte RI, Orringer MB. Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma. Cancer. 1995. 76: 1120-5
18. Smith RS, Miller RC. Incidence of brain metastasis in patients with esophageal carcinoma. World J Gastroenterol. 2011. 17: 2407-10
19. Song Z, Lin B, Shao L, Zhang Y. Brain metastases from esophageal cancer: Clinical review of 26 cases. World Neurosurg. 2014. 81: 131-5
20. Sons HU, Borchard F. Esophageal cancer. Autopsy findings in 171 cases. Arch Pathol Lab Med. 1984. 108: 983-8
21. Takeshima H, Kuratsu J, Nishi T, Soyama N, Miura M, Masumitsu T. Metastatic brain tumours from oesophageal carcinoma: Neuro-imaging and clinicopathological characteristics in Japanese patients. Acta Neurochir. 2001. 143: 31-6
22. Weinberg JS, Suki D, Hanbali F, Cohen ZR, Lenzi R, Sawaya R. Metastasis of esophageal carcinoma to the brain. Cancer. 2003. 98: 1925-33
23. Yoshida S. Brain metastasis in patients with esophageal carcinoma. Surg Neurol. 2007. 67: 288-90