Abstract Details

To examine national practice patterns and survival outcomes in patients with brain metastases from an esophageal primary treated with intracranial radiation.

Brain metastasis from an esophageal primary are a rare occurrence, therefore clinical data regarding management and outcomes are limited. Intracranial radiotherapy in the form of whole brain radiation therapy (WBRT) and/or stereotactic radiosurgery (SRS) are common treatment approaches in management of brain metastases, however the utilization patterns and efficacy of each technique in esophageal based brain metastasis are unknown.

We analyzed 289 stage IV esophageal cancer patients with documented brain metastasis treated with intracranial radiotherapy as reported by the National Cancer Data Base (NCDB) between the years 2004-2014. The treatment arms included those receiving WBRT versus SRS. Univariable and multivariable analyses identified characteristics predictive of overall survival. Multivariable logistic regression identified co-variates associated with each treatment arm.

There were 230 patients in the WBRT group and 59 patients in the SRS group.

With multivariable analysis, SRS receipt was an independent predictor of improved overall survival (HR=0.63, p=0.005) along with receipt of chemotherapy, lower comorbidity score, African American race, and absence of liver/bone metastases (p<0.01). Overall survival (OS) at 1 and 2 years for the WBRT was 17% and 4% (median OS: 4.5 months) compared to 32% and 12% (median OS: 6.9 months) for the SRS arm (p=0.004). Notably, patient age, tumor grade, histology, presence of lung metastasis, and sex were not associated with differences in OS. More recent treatment year was associated with receipt of SRS (p=0.03).

In the largest known analysis of intracranial radiotherapy in esophageal brain metastases to date, receipt of SRS was associated with increased OS compared to WBRT. Given the limitations of a retrospective analysis, these findings require further investigation.