Ghidini Michele, Petrelli Fausto, Hahne Jens Claus, De Giorgi Annamaria, Toppo Laura, Pizzo Claudio, Ratti Margherita, Barni Sandro, Passalacqua Rodolfo, Tomasello Gianluca
Oncology Unit, Oncology Department, ASST di Cremona, Ospedale di Cremona, Viale Concordia 1, 26100, Cremona, Italy.
Oncology Unit, Oncology Department, ASST Bergamo Ovest, Ospedale di Treviglio, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy.
Med Oncol. 2017 Apr;34(4):62. doi: 10.1007/s12032-017-0919-0. Epub 2017 Mar 18.
The aim of the study was to collect the available data on central nervous system (CNS) metastases from esophageal and gastric cancer. A PubMed, EMBASE, SCOPUS, Web of Science, LILACS, Ovid and Cochrane Library search was performed. Thirty-seven studies including 779 patients were considered. Among the data extracted, treatment of tumor and brain metastases (BMs), time to BMs development, number and subsite, extracerebral metastases rate, median overall survival (OS) and prognostic factors were included. For esophageal cancer, the median OS from diagnosis of BMs was 4.2 months. Prognostic factors for OS included: performance status, multimodal therapy, adjuvant chemotherapy, single BM, brain only disease and surgery. For gastric cancer, median OS was 2.4 months. Prognostic factors for OS included: recursive partitioning analysis class 2, stereotactic radiosurgery (SRT) and use of intrathecal therapy. HER2-positive gastric cancer was shown to be associated with a higher risk and shorter time to CNS relapse. Patients harboring BMs from gastric and esophageal tumors, except cases with single lesions that are treated aggressively, have a poor prognosis. SRT (plus or minus surgery and whole brain radiotherapy) seems to give better results in terms of longer OS after brain relapse.
本研究的目的是收集有关食管癌和胃癌中枢神经系统（CNS）转移的现有数据。我们检索了PubMed、EMBASE、SCOPUS、科学网、拉丁美洲和加勒比地区卫生科学数据库、Ovid以及考克兰图书馆。共纳入37项研究，涉及779例患者。提取的数据包括肿瘤和脑转移瘤（BMs）的治疗、BMs发生时间、数量和部位、脑外转移率、中位总生存期（OS）以及预后因素。对于食管癌，从诊断BMs起的中位OS为4.2个月。OS的预后因素包括：体能状态、多模式治疗、辅助化疗、单个BM、仅脑转移疾病以及手术。对于胃癌，中位OS为2.4个月。OS的预后因素包括：递归分割分析2类、立体定向放射外科（SRT）以及鞘内治疗的使用。HER2阳性胃癌显示出与较高风险和较短的CNS复发时间相关。除了单个病灶且积极治疗的病例外，患有来自胃和食管肿瘤BMs的患者预后较差。SRT（加或减手术和全脑放疗）在脑复发后延长OS方面似乎能取得更好的结果。
