Brain metastases in upper gastrointestinal cancers - an underestimated complication in gastrointestinal oncology

Background Brain metastases represent a severe complication in several gastrointestinal malignancies especially those arising from the upper gastrointestinal tract, including cancer of the esophagus, gastro-esophageal junction, and stomach. However, there is little knowledge about the onset or potential risk factors of brain metastases (BRMs) in upper gastrointestinal cancers resulting in a lack of screening guidelines for BRMs.

Aim Determine the incidence and risk factors for BRMs in stomach and eosophegeal cancers

Methods We analyzed 827 patients from our cancer registry suffering from upper gastrointestinal (UGI) cancer and treated at the University Medical Center Göttingen between January 2013 and December 2019 for BRMs.

Results From 827 patients with UGI cancer we found 54 patients with BRMs, resulting in an incidence of 6.5 %. BRMs are more frequent in male patients (90.74 % vs 9.26 %, p = 0.0051) and in adenocarcinomas (90.74 % vs 9.26 %, p = 0.0117). Mean duration for the onset of BRMs from initial cancer diagnoses was 20.9 months in advanced tumors and 9.3 months in metastatic disease (p = 0.0026). However, early detection of BRMs is a prognostic factor since patients with technically resectable metastases have a better prognosis compared to those with unresectable BRMs (5.93 vs 2.07 months, p = 0.0091).

Conclusion Brain metastases occurred with a high frequency (6.5 %), especially in male patients and in patients with adenocarcinomas of the upper gastrointestinal tract. Since survival after diagnosis of brain metastases strongly correlates with the possibility of brain surgery, we suggest a routine screening procedure to detect asymptomatic brain metastases. For early detection, we suggest a routine cerebral MR imaging at initial diagnosis, 12 to 18 months after initial diagnosis in a curative situation and 6 months in a palliative situation, depending on patient performance status.

Publication History

Article published online:
07 September 2021