Incidence of brain metastases following trimodality therapy (TMT) in patients with esophageal and gastroesophageal (E-EGCJ) cancer

108 Background: Brain metastases in E-EGJ cancer patients following TMT are considered rare. We reviewed the cumulative incidence of brain metastases in a large cohort of patients who underwent TMT and had a long follow-up. Methods: Data were analyzedretrospectively for 579 E-EGJ cancer patients who underwent TMT between years 2000 and 2010. None had screening or surveillance brain imaging. Results: Median follow-up time was 57.4 months (95% confidence interval [CI]: 51.5-63.3 months). Common patient characteristics were as follows: median age: 59.5 years (range, 39-74 years), Caucasian ethnicity (90%), male gender (85%), pre-treatment clinical stage III (65%), and adenocarcinoma histology (90%). 197 (34%) of 579 patients developed distant metastases and of these 20 (3% of 579 and 10% of 197) patients developed brain metastases. 18 (90%) patients had brain metastases within the first 24 months (12 in the first 12 months and 6 in the following 12 months) of surgery. 18 (90%) of patients were symptomatic at diagnosis. 15 (75%) of 20 patients had a single metastasis, however, only 4 (25%) patients survived >20 months (overall survival times were [in months]: 20, 30, 92 and 137). The median overall survival time of all 20 patients was 10.8 months (95% CI: 4.7-16.9). Conclusions: 3% of patients with E-EGJ cancer developed brain metastases after TMT and 90% of these occurred within the first 24 months of surgery. A few patients survived ≥20 months. These data rule out the use of screening and surveillance brain imaging for TMT-eligible patients. Supported by UT M. D. Anderson Cancer Center Clinical Research and Generous Donors.