88: BRAIN METASTASIS INCIDENCE IN GASTRO-ESOPHAGEAL CANCER: A META-ANALYSIS

Abstract

Abstract Background and aim Upper gastrointestinal cancers (UGC) are a leading cause of cancer related deaths. Brain metastases (BM) from gastric and esophageal cancer are rare and associated with a poor survival time. In order to establish the most accurate incidence and characteristics of BM in UGC, we decide to review all studies and series published in the last years. Methods We searched the keywords ‘Gastric cancer OR Oesophageal Cancer + Cerebral Metastasis’ in Pubmed, EMBASE, Cochrane Library. Inclusion criteria were all studies treating with BM from UGC cancer. When inclusion criteria were met, we extracted the following endpoints for each study: author, year of publication, country of population, tumor localization, tumor histology, number of BM, synchronous or metachronous BM, other localization of metastases, surgical treatment of the primary tumor, different modality of BM treatment (surgery, steatosic radiosurgery, whole brain radiation, gamma knife surgery), survival and follow-up. Results In the final analysis, we included 52 studies. The number of patients with oesophageal tumor were described in 30 studies with 41636 patients from which 1234 patients (2.9%) had BM. 526 patients (63%) had an adenocarcinoma, 287 (34%) had a SCC and 17 (3%) other histology. BM was unique in 288 patients (50%) and multiples in 282 patients (50%). Combined radiotherapy and surgery was performed in 129 patients (17.9%). Surgical metastasectomy was performed in 172 patients (24.25%). Stereotaxic radiotherapy was delivered in 60 patients (8.5%). Whole brain radiotherapy was performed in 265 patients (35.9%), gamma knife surgery in 43 patients (5.9%), chemotherapy in 10 patients (1.6%) and no treatment in 43 patients (5.9%). Median survival was reported from 3 to 24 months. We identified 12 articles which matched criteria for gastric cancer with a total of 73.781 primary gastric tumors where 645 presented BM (0.87%). We could identify 159 patients with single BM (42.3%) compared to 217 patients with multiple BM (57.7%). We identified 434 adenocarcinoma which represent 81.1% of BM. Median survival was from 1.3 to 27 months with a median survival of 4.2 months. Conclusion BM from UGC are rare but with a low survival. Multimodal treatment is the most described treatment strategy.