764 - Forty-one cases of metastasis from gastric cancer to the central nerve system: experience at single center

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Gastric Cancer
Presenter hirokazu Shoji
Authors H. Shoji1, T. Hamaguchi2, Y. Honma3, S. Iwasa3, K. Kato3, Y. Yamada4, Y. Shimada3
  • 1Gastrointestinal Oncology Dept., national cancer center hospital, 104-0045 - Tokyo/JP
  • 2Gastrointestinal Oncology, National Cancer Center Hospital, JP-104-0045 - Tokyo/JP
  • 3Gastrointestinal Oncolgoy, national cancer center hospital, Tokyo/JP
  • 4Medical Oncology, National Cancer Center Hospital, Tokyo/JP

Abstract

Background

Metastasis from gastric cancer to the central nerve system (CNS) is a rare entity, and there is little information available regarding evaluation of these patients. The purpose of this study was to evaluate the clinical characteristics of gastric cancer patients with CNS metastasis and to clarify treatment outcomes in metastatic gastric cancer to the CNS.

Methods

This retrospective study reviewed data from gastric cancer patients with CNS metastasis treated at our institution from 2000 to 2011.

Results

2195 patients with metastatic gastric cancer were included in this study. 41 of these patients (1.87%) were found to have CNS metastasis (32 men, 9 women; median age, 62.0 years). Leptomeningeal metastases and brain metastases were identified in 11 and 30 patients; Stage IV disease and recurrence were identified in 25 and 16 cases; and main metastatic sites were lymph nodes, peritoneum, liver, and bone in 22, 12, 7 and 6 cases, respectively. Histopathologically, 29 patients (70.7%) had diffuse-type adenocarcinoma. Most frequent symptoms were headache, nausea/emesis, cataplexy, and convulsion. Thirty-six patients received systemic chemotherapy. The median interval from the initiation of systemic chemotherapy to the diagnosis of CNS metastasis was 7.4 months.

Among leptomeningeal patients, 9 patients received symptomatic therapy such as steroid and 2 patients received intrathecal chemotherapy. Median survival time from the diagnosis of leptomeningeal metastases was 27 days. Among brain metastasis patients, 47% had a solitary lesion, while 53% had multiple lesions. Five patients received symptomatic therapy (group 1), 18 patients received radiotherapy (group 2) such as whole-brain radiation therapy or gamma knife radiosurgery, and 7 patients received resection ± radiotherapy (group 3). Median survival time from the diagnosis of brain metastases was approximately 1.8 months for patients in group 1 and 2. Group 3 patients survived longer than group 1 and 2 patients at median 8.4 months.

Conclusions

The treatment outcome in metastatic gastric cancer to the CNS was poor. Among brain metastases patients, patients who received resection ± radiotherapy showed a more favorable outcome compared to other treatment groups.

Disclosure

All authors have declared no conflicts of interest.