OBJECTIVE: This study aimed to evaluate local control (LC) of tumors, patient overall survival (OS), and the safety of stereotactic radiosurgery (SRS) for esophageal cancer brain metastases (EBMs). METHODS: This retrospective cohort study used data from 15 International Radiosurgery Research Foundation facilities encompassing 67 patients with 185 EBMs managed using SRS between January 2000 and May 2022. The median patient age was 63 years, with a male predominance (92.5%). Most patients (64.2%) had a single brain metastasis, while 7.5% had more than 5 metastases. The median tumor volume was 0.9 cm3, and the median margin dose delivered to the tumor was 20 Gy. RESULTS: The median OS post-SRS was 15.2 months, with 1- and 2-year OS rates of 65.7% and 32.3%, respectively. A significant inverse correlation was found between the number of EBMs and OS in the univariable analysis. LC rates at 1 and 2 years were 89% and 76%, respectively. Adverse radiation effects (AREs) were observed in 17.9% of patients, with 13.4% being mild and transient and 4.5% severely symptomatic (Common Terminology Criteria for Adverse Events grade 3). New intracranial disease developed in 58.2% of patients, with 1- and 2-year rates of 58% and 73%, respectively. CONCLUSIONS: SRS for EBMs demonstrated high survival rates and effective tumor control, with a low incidence of severe AREs. These findings highlight the potential role of SRS in the multidisciplinary multimodality management paradigm of EBM.

Ain Shams University Cairo Egypt

Clinical Oncology Ain Shams University Cairo Egypt

Department of Neurological Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania

Department of Neurological Surgery University of Virginia Charlottesville Virginia

Department of Neurosurgery Benha University Benha Egypt

Department of Neurosurgery Humanitas Research Hospital IRCCS Milan Italy

Department of Neurosurgery Koç University School of Medicine Istanbul Turkey; and

Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital Taipei Taiwan

Department of Neurosurgery Université de Sherbrooke Centre de recherche du CHUS Sherbrooke Québec Canada

Department of Neurosurgery University of Alberta Edmonton Alberta Canada

Department of Neurosurgery University of Pennsylvania Philadelphia Pennsylvania

Department of Neurosurgery Yale University School of Medicine New Haven Connecticut

Department of Radiation Oncology Mayo Clinic Florida Jacksonville Florida

Department of Radiation Oncology National Cancer Institute Cairo University Cairo Egypt

Department of Radiation Oncology Virginia Commonwealth University Health System Richmond Virginia

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic

Departments of11Neurosurgery and

Departments of5Radiation Oncology and

Departments of7Neurosurgery and

Gamma Knife Center Jewish Hospital Mayfield Clinic Cincinnati Ohio

Gamma Knife Center Nasser Institute Hospital Cairo Egypt

National Yang Ming Chiao Tung University School of Medicine Hsinchu Taiwan

Neurosurgery The James Cancer Hospital and Solove Research Institute Ohio State University Wexner Medical Center Columbus Ohio

Radiation Oncology Allegheny Health Network Pittsburgh Pennsylvania

Rose Ella Burkhart Brain Tumor and Neuro Oncology Center Neurological Institute Cleveland Clinic Cleveland Ohio

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