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1 An estimated 25% to 35% of cancer cases are complicated by brain metastasis, the development of which is associated with a poor prognosis and an overall median survival of 4.2 months.2 Although brain metastases are frequently diagnosed in patients with lung cancer (48%), breast cancer (15%), testicular cancer (10% to 15%), and malignant melanoma (6% to 10%),3, 4 they rarely arise from gastrointestinal (GI) tract cancers. Bartelt et al5 reported brain metastases in http://www.selleck.cn/products/gsk126.html is rising due in part to an increased use of brain imaging modalities in these patients and prolonged survival associated with more effective systemic treatments.6 Gait disturbances, altered mental status or personality changes, and focal neurologic deficits are the most common clinical manifestations of metastatic brain disease, whereas memory loss and seizures are less common.3, 7 Brain metastases are a late manifestation of GI cancer5 and associated with a median survival of 3.8 months compared with http://www.selleckchem.com/products/Cyclopamine.html report provides a comprehensive review of the incidence, prevalence, epidemiology, risk factors, management, and prognosis of brain metastasis arising from esophageal, gastric, gallbladder, pancreatic, small bowel, and colorectal cancer. Esophageal cancer (including squamous cell carcinoma and adenocarcinoma) is currently the fastest growing malignancy in the United States with an annual incidence of 4.0 per 100,000 people.1, 8 In 2010, the American Cancer Society estimates http://www.selleckchem.com/products/BI-2536.html that there will be 16,640 new cases of esophageal cancer and 14,500 deaths from esophageal cancer.9 Worldwide, esophageal cancer is more prevalent, reaching an incidence of 160 to 540 per 100,000 people in South Africa, China, and Kazakhstan.1 Fifty percent of newly diagnosed patients have unresectable or metastatic disease at the time of diagnosis, typically to the lungs, liver, and adrenal glands.8, 10-12 Brain metastasis from esophageal cancer remains a rare occurrence with approximately 100 clinical cases reported in the world literature (Table 1). Metastatic spread to the brain likely occurs via Batson's vertebral venous plexus, which provides communication between the esophagus and central nervous system (CNS).5, 8, 10 Clinical cohort studies have identified brain metastases in up to 2.1% of esophageal cancer cases and in 1% to 5% of patients in postmortem studies.13-16 Weinberg et al8 reported on 1588 patients treated at The MD Anderson Cancer Center between 1993 and 2001, and identified only 27 patients (1.7%) with esophageal cancer brain metastases, 19 (70%) of whom had concurrent systemic disease.