2269 - Analysis of Brain Metastases from Esophageal Cancer in the Era of Immunotherapy: A Single-Center Retrospective Study

03:00pm - 04:00pm ET

Poster Hall - Exhibit Hall A

Screen: 26

Presenter(s)

Qin Xiao, - National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Shenzhen, Shenzhen, Guangdong

X. Wu¹, Y. Tian¹, X. Wang¹, H. Liu¹, Q. Xiao², and S. Ouyang¹; ¹Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China, ²National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Shenzhen, China

Purpose/Objective(s):

Brain metastases (BM) from esophageal cancer (EC) are clinically rare with extremely poor prognosis. Although data indicate that immunotherapy has improved the prognosis of esophageal cancer, the treatment for patients with brain metastases from esophageal cancer remains to be explored. This study aims to investigate the clinicopathological characteristics, treatment, and prognosis of patients with brain metastases from esophageal cancer.

Materials/Methods:

We retrospectively enrolled pathologically confirmed EC patients treated at our center (April 2015-August 2024) who developed BM at initial diagnosis or following progression. Primary endpoints were intracranial progression-free survival (iPFS) and overall survival (OS).

Results:

Forty-one patients were included: 40 males (97.6%), 35 squamous carcinoma (85.4%), 25 T3 (60.1%), 33 N+ (80.4%). Synchronous BM occurred in 21 (51.2%). At BM diagnosis, 70.7% were asymptomatic; solitary lesions were common (22, 53.7%). Systemic therapy was administered to 35 patients, with 25 receiving immunotherapy post-BM. Local treatment was received by 17 patients (15 radiotherapy alone, 1 surgery+radiotherapy, 1 surgery alone). For 16 receiving palliative radiotherapy: 12 received local radiotherapy (median dose 32.5Gy,15-60.77Gy), delivered in fractions of 1.8-7.0 Gy over 5-25 sessions; 4 received whole-brain radiotherapy(3 received 30 Gy in 10 fractions, 1 received 36 Gy in 18 fractions). As of March 25 , 2025, 4 patients survived,the follow-up of survivors after diagnosis of brain metastases ranged from 7 to 16 months.The radiotherapy group showed better outcomes: median iPFS 9.0 vs 3.0 months (p=0.046), median OS 14.0 vs 6.0 months (p=0.021). Intracranial progression occurred in 18 patients (11 radiotherapy, 7 no-radiotherapy), with isolated local failure most common (12, 66.7%). Among 11 radiotherapy patients with progression: of 4 WBRT patients, 2 progressed (both isolated local failure ); of 12 local radiotherapy patients, 9 progressed (2 isolated local failure , 2 isolated local failure +new lesions, 5 new lesions only). Among 12 isolated local failure progression patients, 6 received radiotherapy (median dose 45.6Gy). Among 6 new-lesion-only patients, 5 received radiotherapy (median dose 59.5Gy).

Conclusion:

Local radiotherapy for EC brain metastases may improve iPFS and OS. Local failure remains common; optimal radiotherapy modality and dose warrant further investigation.