Metachronic Brain Metastases After Esophagectomy for Esophageal Cancer (METABREC)

Study Overview
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Brief Summary
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Esophagectomy is the cornerstone of the curative treatment of esophageal carcinoma. Despite this treatment, patients can suffer from locoregional or distant metastatic disease and only a very selected group of patients can be cured: mostly those with recurrence in one single organ. Brain metastases are rare after esophagectomy for cancer, but they have a serious impact on survival. Agressive treatment is often moren difficult for brain metastases compared to other metastases and some risk factors have been identified earlier. There is an impression that the incidence of brain metastases in esophageal cancer patients has increased since the introduction of neoadjuvant treatment schemes. However, this is not clear yet. A potential explanation could be that chemotherapy disturbs the blood-brain-barrier, hereby facilitating the migration of tumor cells to the brain. The purpose of this study is to retrospectively analyze the incidence and potential risk factors of brain metastases in patients who underwent esophagectomy for esophageal cancer. Patients treated between 2000 and 2019 will be included and outcome parameters are Odds Ratio for brain metastases (comparison between primary surgery and neoadjuvant treatment followed by surgery), time to recurrence and risk factors, number and characteristics of the brain metastases.

Official Title
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Risk Factors and Treatment Options for Metachronic Brain Metastases After Esophagectomy for Esophageal Cancer: a Multicentric Retrospective Cohort Study (METABREC)

Conditions
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Esophageal Neoplasms, Esophagectomy, Brain Metastases

Intervention / Treatment
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* Procedure: Esophagectomy for esophageal cancer


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients receiving surgical treatment for esophageal cancer between 1 januari 2000 and 31 december 2019 All types of neoadjuvant treatment followed by surgery, primary surgery or salvage surgery. Adenocarcinoma or squamous cell carcinoma histology Exclusion Criteria: other histology type than adenocarcinoma or squamous cell carcinoma Hypopharyngeal carcinoma extending to the esophagus (requiring total laryngo-pharyngo-esophagectomy) Early esophageal carcinoma (cT IS-1a N0 M0) palliative esophagectomy
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Esophagectomy for esophageal cancer|Surgical removal of (a part of) the esophagus and surgical reconstruction with another organ (mostly stomach, but may be colon or small bowel as well)|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Odds ratio (OR) for brain metastasis | Odds ratio (OR) for brain metastasis compared between primary surgery and neoadjuvant treatment plus surgery, OR for different neoadjuvant treatment regimes, corrected for gender and tumor factors (histology, stage, tumor differentiation,…) . | 1 January 2000 - 1 March 2020 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall survival | Overall survival after diagnosis of brain metastases stratified for treatment regimens applied. | 1 January 2000 - 1 March 2020 | 
| Time to recurrence | Time to recurrence, between incidence date of esophageal cancer and diagnosis of brainM+ | 1 January 2000 - 1 March 2020 | 
| Risk factors for single site brain metastasis | such as different neoadjuvant treatment regimes, age, gender,and tumor factors (histology, stage, tumor differentiation,…) | 1 January 2000 - 1 March 2020 | 
| Number of brain metastases | Number of brain metastases | 1 January 2000 - 1 March 2020 | 
| Characteristics of brain metastases | solitary/multiple; location /side in the brain; treatment) and the effects on 'OS after recurrence' (e.g. is there a significant survival benefit in patients with brainM+ if they are treated with brain-surgery and/or stereotactic radiotherapy compared to non-treated BrainM+ or palliative treatments of brainM+ | 1 January 2000 - 1 March 2020 |