Division of Radiation Oncology, Shizuoka Cancer Center Hospital, Japan.
J Radiat Res. 2011;52(4):509-15. doi: 10.1269/jrr.10184. Epub 2011 Apr 14.
Brain metastasis from esophageal carcinoma has been considered rare and survival following esophageal carcinoma with distant metastasis is poor. The purpose of this report was to clarify cumulative incidence and risk factors for brain metastasis after chemoradiotherapy for esophageal carcinoma, and to consider recommended treatments for brain metastasis from esophageal carcinoma. We reviewed 391 patients treated with chemoradiotherapy. Median age was 65 years. Clinical stages were I, II, III, and IV in 32, 47, 150, and 162 patients, respectively. Brain imaging was performed usually when patients revealed neurological symptoms. The 3-year cumulative incidence of brain metastasis after chemoradiotherapy was 6.6%. There were 4 patients with single metastasis and 8 with multiple metastases. Initial clinical stages were II, III, and IV in 1, 2, and 9 patients, respectively. Histology included squamous cell carcinoma in 10 patients and others in 2 patients. Univariate analysis demonstrated M factor, distant lymph node relapse, and recurrent lung and liver metastasis as significant risk factors of brain metastasis (P < 0.05). Median survival time after diagnosis of brain metastasis was 2.1 months. Brain metastasis was not directly related to cause of mortality. The causes were extracranial tumor deterioration in 8 patients and infection in 4 patients. Brain metastasis may increase in the future with improving survival from esophageal carcinoma. However, considering the poor survival after diagnosis of brain metastasis, short-term palliative therapy for brain metastasis appears preferable to vigorous long-term therapy.
脑转移食管癌已被认为是罕见的，并且伴有远处转移的食管癌患者的生存状况较差。本报告的目的是阐明食管癌放化疗后发生脑转移的累积发生率和危险因素，并考虑食管癌脑转移的推荐治疗方法。我们回顾了 391 例接受放化疗的患者。中位年龄为 65 岁。临床分期分别为 I 期、II 期、III 期和 IV 期患者为 32、47、150 和 162 例。当患者出现神经症状时，通常会进行脑部影像学检查。放化疗后 3 年脑转移的累积发生率为 6.6%。有 4 例为单发转移，8 例为多发转移。初诊时临床分期分别为 II 期、III 期和 IV 期的患者分别为 1、2 和 9 例。组织学包括 10 例鳞状细胞癌和 2 例其他类型癌。单因素分析表明，M 因子、远处淋巴结复发、复发性肺和肝转移是脑转移的显著危险因素（P<0.05）。脑转移诊断后的中位生存时间为 2.1 个月。脑转移与死亡原因无直接关系。8 例患者因颅外肿瘤恶化，4 例患者因感染导致死亡。随着食管癌生存率的提高，脑转移的发生率可能会增加。然而，考虑到脑转移诊断后的生存状况较差，脑转移的短期姑息性治疗似乎优于长期强化治疗。
