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Gamma knife radiosurgery for management of cerebral metastases from esophageal carcinoma

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Abstract

Esophageal carcinoma rarely results in intracranial metastases but when it does, the patient prognosis is grim. Because of its rarity outcomes after stereotactic radiosurgery (SRS) are not known. We sought to evaluate the outcomes of SRS in the management of esophageal cancer that has spread to the brain. This single institution retrospective analysis reviewed our experience with esophageal metastasis from 1987 to 2013. Thirty patients (36 SRS procedures) with a median age of 59 (37–86 years) underwent Gamma knife® SRS. The esophageal origin was adenocarcinoma in 26 patients (87 %), squamous cell carcinoma in 3 patients (10 %), and mixed neuroendocrine carcinoma in 1 patient (3 %). Fifteen patients were treated for a single metastasis and 15 patients were treated for multiple metastases for a total of 87 tumors. The median tumor volume was 5.7 cm3 (0.5–44 cm3) with a median marginal dose of 17 Gy (12–20 Gy). The median survival time from the diagnosis of brain metastasis was 8 months and the median survival from SRS was 4.2 months. This corresponded to a 6-month survival of 45 % and a 12-month survival of 19 % after SRS. A higher KPS at the time of procedure was associated with an increase in survival (p = 0.023). The local tumor control rate in this group was 92 %. Four patients had repeat SRS for new metastatic deposits. One patient developed a new neurological deficit after SRS. SRS proved an effective means of providing local control for esophageal metastases to the brain. Concomitant systemic disease progression at the time of brain metastasis resulted in poor long-term survival.

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References

  1. Howlader N, Noone A-M, Yu M, Cronin KA (2012) Use of imputed population-based cancer registry data as a method of accounting for missing information: application to estrogen receptor status for breast cancer. Am J Epidemiol 176:347–356

    Article  PubMed Central  PubMed  Google Scholar 

  2. Hur C, Miller M, Kong CY, Dowling EC, Nattinger KJ, Dunn M, Feuer EJ (2013) Trends in esophageal adenocarcinoma incidence and mortality. Cancer 119:1149–1158

    Article  PubMed Central  PubMed  Google Scholar 

  3. Townsend CM, DanielBeauchamp R, Mark Evers B, Mattox KL (2004) Sabiston textbook of surgery. W B Saunders Company, Philadelphia

    Google Scholar 

  4. Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29

    Article  PubMed  Google Scholar 

  5. Weinberg JS, Suki D, Hanbali F, Cohen ZR, Lenzi R, Sawaya R (2003) Metastasis of esophageal carcinoma to the brain. Cancer 98:1925–1933

    Article  PubMed  Google Scholar 

  6. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751

    Article  CAS  PubMed  Google Scholar 

  7. Smith RS, Miller RC (2011) Incidence of brain metastasis in patients with esophageal carcinoma. World J Gastroenterol 17:2407–2410

    Article  PubMed Central  PubMed  Google Scholar 

  8. Quint LE, Hepburn LM, Francis IR, Whyte RI, Orringer MB (1995) Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma. Cancer 76:1120–1125

    Article  CAS  PubMed  Google Scholar 

  9. Go PH, Go PH, Klaassen Z, Klaassen Z, Meadows MC, Meadows MC, Chamberlain RS, Chamberlain RS (2011) Gastrointestinal cancer and brain metastasis. Cancer 117:3630–3640

    Article  PubMed  Google Scholar 

  10. Song Z, Song Z, Lin B, Lin B, Shao L, Shao L, Zhang Y, Zhang Y (2013) Brain metastases from esophageal cancer: clinical review of 26 cases. World Neurosurg. doi:10.1016/j.wneu.2013.02.058

    Google Scholar 

  11. Yoshida S (2007) Brain metastasis in patients with esophageal carcinoma. Surg Neurol 67:288–290

    Article  PubMed  Google Scholar 

  12. Da Silva AN, Nagayama K, Schlesinger DJ, Sheehan JP (2009) Gamma knife surgery for brain metastases from gastrointestinal cancer. J Neurosurg 111(3):423–430

    Article  PubMed  Google Scholar 

  13. Hasegawa T, Kondziolka D, Flickinger JC, Lunsford LD (2003) Stereotactic radiosurgery for brain metastases from gastrointestinal tract cancer. Surg Neurol 60:506–514 discussion 514–515

    Article  PubMed  Google Scholar 

  14. Monaco EA, Monaco EA, Faraji AH et al (2012) Leukoencephalopathy after whole-brain radiation therapy plus radiosurgery versus radiosurgery alone for metastatic lung cancer. Cancer. doi:10.1002/cncr.27504

    PubMed  Google Scholar 

  15. Aoyama H, Aoyama H, Tago M et al (2007) Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone. Int J Radiat Oncol Biol Phys 68:1388–1395

    Article  PubMed  Google Scholar 

  16. Chang EL, Chang EL, Wefel JS et al (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10:1037–1044

    Article  PubMed  Google Scholar 

  17. Yates JW, Chalmer B, McKegney FP (1980) Evaluation of patients with advanced cancer using the Karnofsky performance status. Cancer 45:2220–2224

    Article  CAS  PubMed  Google Scholar 

  18. Gaspar LE, Scott C, Murray K, Curran W (2000) Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys 47:1001–1006

    Article  CAS  PubMed  Google Scholar 

  19. Serizawa T, Higuchi Y, Nagano O, Hirai T, Ono J, Saeki N, Miyakawa A (2012) Testing different brain metastasis grading systems in stereotactic radiosurgery: Radiation Therapy Oncology Group’s RPA, SIR, BSBM, GPA, and modified RPA. J Neurosurg 117(Suppl):31–37

    PubMed  Google Scholar 

  20. Monaco E, Monaco E, Kondziolka D et al (2008) Management of brain metastases from ovarian and endometrial carcinoma with stereotactic radiosurgery. Cancer 113:2610–2614

    Article  PubMed  Google Scholar 

  21. Rice TW, Khuntia D, Rybicki LA, Adelstein DJ, Vogelbaum MA, Mason DP, Murthy SC, Blackstone EH (2006) Brain metastases from esophageal cancer: a phenomenon of adjuvant therapy? Ann Thorac Surg 82:2042–2049 2049.e1–2049.e2

    Article  PubMed  Google Scholar 

  22. Ogawa K, Toita T, Sueyama H, Fuwa N, Kakinohana Y, Kamata M, Adachi G, Saito A, Yoshii Y, Murayama S (2002) Brain metastases from esophageal carcinoma: natural history, prognostic factors, and outcome. Cancer 94:759–764

    Article  PubMed  Google Scholar 

  23. Bhatnagar AK, Bhatnagar AK, Flickinger JC, Flickinger JC, Kondziolka D, Kondziolka D, Lunsford LD, Lunsford LD (2006) Stereotactic radiosurgery for four or more intracranial metastases. Int J Radiat Oncol Biol Phys 64:898–903

    Article  PubMed  Google Scholar 

  24. Lee C–C, Yen C-P, Xu Z, Schlesinger D, Sheehan J (2014) Large intracranial metastatic tumors treated by Gamma Knife surgery: outcomes and prognostic factors. J Neurosurg 120:52–59

    Article  PubMed  Google Scholar 

  25. Lippitz B, Lindquist C, Paddick I, Peterson D, O’Neill K, Beaney R (2014) Stereotactic radiosurgery in the treatment of brain metastases: the current evidence. Cancer Treat Rev 40:48–59

    Article  PubMed  Google Scholar 

  26. Jagannathan J, Jagannathan J, Yen C-P et al (2009) Gamma Knife radiosurgery to the surgical cavity following resection of brain metastases. J Neurosurg 111:431–438

    Article  PubMed  Google Scholar 

  27. Muacevic A, Wowra B, Siefert A, Tonn J-C, Steiger H-J, Kreth FW (2008) Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicentre phase III trial. J Neurooncol 87:299–307

    Article  PubMed  Google Scholar 

  28. Patchell RA (1996) The treatment of brain metastases. Cancer Invest 14:169–177

    Article  CAS  PubMed  Google Scholar 

  29. Noordijk EM, Vecht CJ, Haaxma-Reiche H, Padberg GW, Voormolen JH, Hoekstra FH, Tans JT, Lambooij N, Metsaars JA, Wattendorff AR (1994) The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 29:711–717

    Article  CAS  PubMed  Google Scholar 

  30. Prabhu R, Prabhu R, Shu H-K et al (2012) Current dosing paradigm for stereotactic radiosurgery alone after surgical resection of brain metastases needs to be optimized for improved local control. Int J Radiat Oncol Biol Phys 83:e61–e66

    Article  PubMed  Google Scholar 

  31. Aoyama H, Aoyama H, Shirato H et al (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 295:2483–2491

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors thank Professor Douglas Kondziolka, MD (New York University Langone Medical Center) for significant contribution to patient management at University of Pittsburgh.

Conflict of interest

Dr. Lunsford is a consultant and stockholder for AB Elekta.

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Authors and Affiliations

  1. Department of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Greg Bowden, Hideyuki Kano, Zachary J. Tempel, Ellen Caparosa, Edward Monaco III, Ajay Niranjan & L. Dade Lunsford

  2. Department of Radiation Oncology, Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA

    John Flickinger

  3. Department of Thoracic Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA

    James D. Luketich

  4. Department of Ontario, University of Western Ontario, London, ON, Canada

    Greg Bowden

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  1. Greg Bowden
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  2. Hideyuki Kano
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  9. L. Dade Lunsford
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Correspondence to Hideyuki Kano.

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Bowden, G., Kano, H., Tempel, Z.J. et al. Gamma knife radiosurgery for management of cerebral metastases from esophageal carcinoma. J Neurooncol 118, 141–146 (2014). https://doi.org/10.1007/s11060-014-1408-3

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  • DOI: https://doi.org/10.1007/s11060-014-1408-3

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