Solitary intracranial metastasis as the sole relapse site in gastric cancer patients after neoadjuvant therapy and surgery: a case series of 12 patients and clinical implications.

BACKGROUND

Gastric cancer recurrence commonly involves the peritoneum, liver, and lungs, whereas isolated intracranial metastasis is rare, particularly in patients receiving neoadjuvant therapy and surgery. This study aimed to characterize a distinct subgroup of patients with isolated intracranial recurrence after neoadjuvant treatment and radical surgery.

METHODS

We retrospectively reviewed patients with gastric cancer who underwent neoadjuvant therapy followed by curative resection and subsequently developed isolated intracranial metastasis confirmed by whole-body imaging. Clinical and pathological features were systematically analyzed.

RESULTS

Twelve patients met the inclusion criteria. All patients were lymph node-positive (100%). The primary tumor was located at the cardia or esophagogastric junction in 11 patients (91.7%). Poorly differentiated histology was observed in eight patients (66.7%), while the remaining four (33.3%) had moderately differentiated tumors; no well-differentiated cases were identified. The median time from surgery to intracranial metastasis was 15.3 months (95% confidence interval: 9.0-21.6 months).

CONCLUSIONS

Isolated intracranial metastasis after neoadjuvant therapy for gastric cancer is associated with a distinct clinical profile: cardia/esophagogastric junction location, positive lymph node status, and poorly differentiated histology. Recognition of this high-risk profile may facilitate early diagnosis and inform surveillance strategies in this patient population.