Abstract
About 10% of all cancer patients will develop brain metastases during advanced disease progression. Interestingly, the vast majority of brain metastases occur in only three types of cancer: Melanoma, lung and breast cancer. In this review, we focus on summarizing the prognosis and impact of surgical resection of brain metastases originating from gastrointestinal cancers such as esophageal, gastric, pancreatic and colorectal cancer. The incidence of brain metastases is <1% in pancreatic and gastric cancer and <4% in esophageal and colorectal cancer. Overall, prognosis of these patients is very poor with a median survival in the range of only months. Interestingly, a substantial number of patients who had received surgical resection of brain metastases showed prolonged survival. However, it should be taken into account that all these studies were not randomized and it is likely that patients selected for surgical treatment presented with other important prognostic factors such as solitary brain metastases and exclusion of extra-cranial disease. Nevertheless, other reports have demonstrated long-term survival of patients upon resection of brain metastases originating from gastrointestinal cancers. Thus, it appears to be justified to consider aggressive surgical approaches for these patients.
Highlights
Despite considerable progress in diagnostics and therapy, successfully treating cancer still remains one of the major challenges in medicine today since (i) incidence is increasing due to aging and growth of the world’s population and (ii) cancer still remains a leading cause of death worldwide [1].At diagnosis, patients are initially staged for local progression and systemic spread of their disease which, together, determine whether a curative therapeutic approach is considered or not
Occurrence of distant metastases does not denote a palliative situation in colorectal cancer and metastatic surgery is performed within a curative therapeutic concept [72]
In line with this consideration, most studies discussed in this review found that surgical treatment of brain metastases originating from these cancers may prolong patient survival
Summary
Despite considerable progress in diagnostics and therapy, successfully treating cancer still remains one of the major challenges in medicine today since (i) incidence is increasing due to aging and growth of the world’s population and (ii) cancer still remains a leading cause of death worldwide [1]. The likeliness of their development largely depends on the primary tumor entity since the vast majority of brain metastases arise from only three human cancers: melanoma, lung- and breast cancer [5]. Our comprehensive analysis of clinical studies which investigated incidence and outcome of brain metastases originating from different gastrointestinal cancers confirmed a very low incidence. Whilst the incidence of brain metastasis originating from gastric and pancreatic cancer is below 1%, its incidence is reported to be as high as 4% in esophageal and colorectal cancer (Table 1) The reasons for these differences remain unclear. Clinical studies of the last 15 years about brain metastases in esophageal, gastric, pancreatic and colorectal cancer are summarized with a focus on prognosis and the role of surgery in the therapy of brain metastasis in these cancer entities
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