Surgical Treatment of Brain Metastases of Esophageal Cancer

The incidence of brain metastasis from esophageal cancer is low, ranging from 1.4 to 5%. Symptoms of brain metastases vary depending on the affected areas. The possibility of early diagnosis of brain metastases in esophageal cancer patients may be difficult. Risk factors for brain metastasis include larger tumor sizes and advanced stages of cancer. While adenocarcinomas are more commonly associated with brain metastases in Western countries, squamous cell carcinomas are more common in some Asian countries. However, the histology of the tumor is not considered an independent risk factor for brain metastasis in esophageal cancer. The presence of bone and lung metastasis, younger age, higher N stage, and liver metastases are positively associated with the development of brain metastasis. The diagnosis can be made using brain CT, MRI, or PET imaging when the patient shows neurological symptoms or has a large primary tumor. Advanced MRI methods, such as MR spectroscopy, perfusion-weighted imaging, and diffusion-weighted imaging, provide valuable information about tumor biology. To improve the patient’s survival and restore neurological function, definitive treatment focused on malignancy and supportive treatment to manage complications are performed. They include whole-brain radiotherapy (WBRT) or stereotactic radiotherapy, chemotherapy alone, or surgery combined with radiotherapy. Surgical resection (SR) is the optimal treatment for patients with solitary metastasis, while in patients with multiple brain metastases, surgery may not be suitable. Adjuvant WBRT to surgery has been shown to increase survival rates compared to using WBRT alone.