Brain Metastasis in Patients with Esophageal Squamous Cell Carcinoma: A Single Institute Experience in Southern Taiwan

Abstract

Background: Patients with esophageal squamous cell carcinoma typically have poor outcomes. The lungs, liver, bone, pleura and adrenal gland are the most common sites of visceral metastasis, though metastasis to the brain is exceedingly rare. To date, there have been few reports concerning the clinical outcome of brain metastasis in esophageal squamous cell carcinoma. Therefore, we performed a retrospective review of esophageal squamous cell carcinoma patients with brain metastasis to assess the incidence of brain metastasis and their prognosis.Methods: Between January 1996 and December 2011, 1011 patients with esophageal squamous cell carcinoma were retrospectively reviewed, and 14 patients with brain metastases were identified. The review and diagnoses of brain metastasis were established using brain computer tomography (CT) scan, or magnetic resonance imaging (MRI).Results: The incidence of brain metastasis in our series was 1.4%, and the median survival duration from the diagnosis of brain metastasis in these 14 patients with esophageal squamous cell carcinoma was 1.9 months. The median follow-up period from the diagnosis of esophageal cancer to the diagnosis of brain metastasis was 6.6 months. Systemic metastasis upon diagnosis of brain metastasis was found in 10 patients (71%), a single brain metastasis was found in 6 patients (43%), two brain lesions were found in 2 patients (14%), and multiple brain metastases were found in 6 patients (43%). Primary treatment consisted of whole brain irradiation therapy (WBRT) alone in 5 patients (36%), surgical resection in 6 patients (43%), 5 of whom (36%) subsequently were treated with WBRT, and best supportive care in three patients (21%). Univariate analysis showed that patients with single brain metastasis (P = 0.004), treatment with surgical resection plus whole brain radiation therapy (P = 0.002), and absence of systemic metastasis (P = 0.03) were significantly associated with better clinical outcome.Conclusions: The incidence of brain metastasis in esophageal squamous cell carcinoma is 1.4%, and the prognosis is poor. Patients without systemic metastases or with single brain metastasis have significantly superior survival rates, suggesting that aggressive therapy should be considered in these groups of patients.