Forty-One Cases of Metastases From Gastric Cancer to the Central Nerve System: Experience at a Single Institution

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 between January 2000 and July 2011. Results: 2195 patients with metastatic gastric cancer were included in this study. 41 of these patients (1.87%) were found to have CNS metastases (32 men, 9 women; median age, 62.0 years). Brain metastases (BM) and leptomeningeal metastases (LM) were identified in 30 and 11 patients; and main metastatic sites were lymph nodes, peritoneum, bone, and liver in 15, 10, 4 and 3 cases, respectively. Histopathologically, 29 patients (70.7%) had diffuse-type adenocarcinoma. Most frequent symptoms were headache, nausea/emesis, cataplexy, and seizure. Among BM patients, 47% had a solitary lesion, while 53% had multiple lesions. Five patients received symptomatic therapy, 18 patients received radiotherapy, and 7 patients received resection with/ without radiotherapy. The longest median survival was observed in patients treated with resection with/without radiotherapy (255days). On the other hand, among patients with LM, 9 patients received symptomatic therapy and 2 patients received intrathecal (IT) chemotherapy. Patients received IT chemotherapy survived longer than patients received symptomatic therapy at median 43 days. Conclusions: The treatment outcomes in metastatic gastric cancer to the CNS were poor.