Gastric cancer and metastasis to the brain

Background: Metastasis of gastric carcinoma to the brain is very uncommon. At The University of Texas M. D. Anderson Cancer Center (M. D, Anderson), l ess than 1% of patients with primary gastric carcinoma are found to have br ain metastases. Little has been published regarding the evaluation and trea tment of these patients. The purpose of this study was to review our experi ence with gastric cancer metastatic to the brain and to describe the effica cy of the treatment used. Methods: Between 1957 and 1997, a total of 218,690 patients were seen for e valuation of malignant tumors at M. D. Anderson. Of these patients, 3320 (1 .5%) had a diagnosis of gastric cancer; however, only 24 patients (0.7%) we re found to have brain metastases on imaging studies or at autopsy. We perf ormed a retrospective review of these 24 patients and divided them into thr ee groups on the basis of the treatment they received. Results: Group 1 included patients who received steroids alone (16 mg of de xamethasone, daily). Group 2 patients received 3000 cGy of whole-brain radi ation therapy (WBRT) delivered in 10 fractions in addition to steroids. Gro up 3 patients were managed with surgical resection, WBRT, and steroids. The re were 18 male and 6 female patients, with a median age of 53 years. The m ost common presenting symptoms were weakness, difficulty with balance, and headache. Of the 19 patients diagnosed antemortem, II patients developed ne urological symptoms after the primary diagnosis of gastric carcinoma, where as 8 patients developed neurological symptoms before the diagnosis of gastr ic cancer. Forty-five percent of patients had a single brain metastasis, wh ereas 55% had multiple lesions. All patients had systemic disease, with bon e, liver, and lung involvement seen in 46%, 42%, and 29%, respectively. Nin eteen of 24 patients received treatment after diagnosis of brain metastases . Four patients received steroids only (group 1), 11 patients received WBRT and steroids (group 2), and 4 patients were treated with surgery, WBRT, an d steroids (group 3). Median survival was approximately 2 months for patien ts in groups 1 and 2, whereas group 3 patients had a median survival of sli ghtly greater than 1 year. Conclusions: Our results suggest that the overall prognosis of patients wit h brain metastases from gastric cancer is extremely poor (median survival, 9 weeks). WBRT, as an adjuvant to steroid treatment, was not effective in i mproving outcome in our series. In selected patients, most of whom were rel atively young and had less advanced systemic disease, surgical resection fo llowed by WBRT was associated with relatively long survival times (median s urvival, 54 weeks).