Brain metastases from colon cancer

Cascino, Terrence L.; Leavengood, John M.; Kemeny, Nancy E.; Posner, Jerome B.

doi:10.1007/bf00165604

Cited by 131 publications

(78 citation statements)

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“…Some authors have postulated that a diagnosis of pulmonary metastases in mCRC patients may confer an increase in the risk of developing CNS metastases, supporting Ewing's theory 17 . Chyun 18 also noted that the lag time from primary CRC diagnosis to pulmonary metastases occurred three times earlier among patients who subsequently developed brain metastases. In our registry, we found also that approximately half of the diagnoses of brain metastases were associated with co-existing hepatic involvement (47%), although this was not dramatically higher than those of the whole registry population (35%).…”

Section: Discussionmentioning

confidence: 95%

Brain metastasis in advanced colorectal cancer: Results from the South Australian metastatic colorectal cancer (SAmCRC) registry

et al. 2016

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Objective: Brain metastasis is considered rare in metastatic colorectal cancer (mCRC); thus, surveillance imaging does not routinely include the brain. The reported incidence of brain metastases ranges from 0.6% to 3.2%. Methods:The South Australian mCRC Registry (SAmCRC) was analyzed to assess the number of patients presenting with brain metastasis during their lifetime. Due to small numbers, a descriptive analysis is presented. Results:Only 59 patients of 4,100 on the registry at the time of analysis had developed brain metastasis (1.4%). The clinical characteristics of those with brain metastasis were as follows: the median age was 65.3 years and 51% were female. Where the VKi-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation status of the tumor was known, the majority harbored a KRAS mutation (55%); 31 (53%) underwent craniotomy and 55 (93%) underwent whole-brain radiotherapy. The median survival time from diagnosis of brain metastasis was 4.2 months (95% confidence interval 2.9-5.5). Patients who underwent craniotomy and radiotherapy had superior survival compared to those who underwent whole-brain radiotherapy (8.5 months vs. 2.2 months, respectively). Data from the SAmCRC (a population-based registry) confirm that brain metastases are rare and the median time to development is approximately 2 years. Conclusions: Brain metastasis is a rare outcome in advanced CRC. Patients within the registry tended to be female, young in age, and harbored with higher rates of KRAS mutations. Whether routine surveillance brain scanning should be considered remains controversial given the relative rarity of developing brain metastases in mCRC and ultimately, most patients with central nervous system involvement die from their extracranial disease.

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Section: Discussionmentioning

confidence: 95%

Brain metastasis in advanced colorectal cancer: Results from the South Australian metastatic colorectal cancer (SAmCRC) registry

et al. 2016

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“…BM often are the sole site of failure in nonsmall cell lung cancer, whereas systemic disease usually precedes BM in CRC, because tumor cells generally must pass through both the liver and the lung before reaching the brain hematogenously. 10,31 Therefore, the presence of extracranial disease precludes patients from an RPA Class I classification.…”

Section: Discussionmentioning

confidence: 99%

“…7,8,[10][11][12][13][14] In contrast, >25% of patients with lung cancer develop BM. 15,16 Unfortunately, patients with BM from CRC do not survive as long as patients with BM from other histologies.…”

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confidence: 99%

“…6,17,18 This probably is secondary to the burden of systemic disease in patients with metastatic CRC to the brain; concomitant extracerebral metastases have been demonstrated in 77% to 97% of patients. 10,11,17,19 However, as improvements in the management of CRC have altered the natural history of this disease, the incidence of metastases at previously uncommon sites, such as the brain and bone, is increasing. 20 Therefore, careful consideration needs to be given to the management of this previously rare complication.…”

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confidence: 99%

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Multidisciplinary management of colorectal brain metastases

Kruser

Chao

Elson

et al. 2008

Cancer

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BACKGROUND.The incidence of brain metastases (BM) from colorectal cancer (CRC) is increasing, and the management of this previously rare complication at a single institution is reported.METHODS.The records of all patients with BM from 1994 to 2005 were reviewed, and 49 patients (33 men, 16 women) with 102 BM from CRC were identified. Associations between patient and tumor characteristics, treatment modality, and survival were assessed.RESULTS.The median age at diagnosis of BM from CRC was 66 years. Forty patients (82%) had other systemic disease. The median survival after a diagnosis of BM from CRC was 5.1 months. Fifteen patients (31%) underwent surgery at some point, 14 patients (29%) underwent stereotactic radiosurgery (SRS), and 42 patients (86%) received whole‐brain radiotherapy during their management. Seven patients (14%) underwent upfront SRS. On multivariate analysis, a longer interval from diagnosis of CRC to diagnosis of BM was associated significantly with shorter survival (p = .01). Sex, Karnofsky performance status, tumor location, recursive partitioning analysis class, and initial treatment modality did not have an impact on survival.CONCLUSIONS.Because BM from CRC are a late‐stage phenomenon, the majority of patients in the current study had other systemic involvement, and survival after CNS involvement was poor. The results indicated that a high prevalence of systemic disease limits the proportion of patients who are strong candidates for upfront SRS, thereby limiting the impact that this modality has on outcomes in this population as a whole. Late development (>1 year after the primary tumor diagnosis) of CNS involvement may predict for poorer survival after therapy for patients with BM from CRC. Cancer 2008. © 2008 American Cancer Society.

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“…However, only a few intracranial metastases arise from primary colon cancer. Previous autopsy studies have shown that the incidence of brain metastases from colon cancer is less than 4% [1][2][3][4]. The most common primary sites are the sigmoid colon and rectum [5][6][7].…”

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confidence: 99%

Solitary Cerebellar Metastasis of Cecal Cancer, Visualized Using F-18 FDG PET/CT

Yang

Hong

2011

Nucl Med Mol Imaging

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Intracranial metastases are common in cancer patients. However, only a few intracranial metastases arise from primary colon cancer. Previous autopsy studies have shown that the incidence of brain metastases from colon cancer is less than 4% [1][2][3][4]. The most common primary sites are the sigmoid colon and rectum [5][6][7]. Brain metastases with concomitant liver and/or lung metastases occur more frequently than brain metastases alone [5]. Metastases to the brain most commonly occur by a hematogenous route via the portal venous system, through the liver, heart, lungs, and, finally, the carotids. Cerebellar tumors may occur in association with adenomas/adenocarcinomas of the colon in patients with Turcot's syndrome [8]. However, in Turcot's syndrome, the histological features of the brain tumor differ from those of the colon tumor and the brain tumor is not an adenoma or adenocarcinoma. The cerebellar metastasis in our patient was metachronously detected, and F-18 FDG PET/CT did not show any other metastatic lesions. To the best of our knowledge, this is the first F-18 FDG PET/CT Fig. 1 Brain MRI scan obtained when the patient presented with dizziness showed a 2-cm round mass that was located in the right subtentorial area and showed gadolinium enhancement. The patient had undergone a right hemicolectomy with ileostomy for cecal adenocarcinoma, 1 year prior to presentation. He underwent right hemicolectomy with ileostomy for the treatment of the cecal cancer. The serum carcinoembryonic antigen level decreased to within the normal range in 10 months after surgery (postoperative level, 3.94 ng/ mL; preoperative level, 7.59 ng/mL). The patient presented with dizziness 1 year after surgery. The brain MRI scan obtained at this time showed a 2-cm round mass that was located in the right subtentorial area and showed gadolinium enhancement, i.e., findings suggestive of an intraaxial tumor

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Brain metastases from colon cancer

Cited by 131 publications

References 18 publications

Brain metastasis in advanced colorectal cancer: Results from the South Australian metastatic colorectal cancer (SAmCRC) registry

Brain metastasis in advanced colorectal cancer: Results from the South Australian metastatic colorectal cancer (SAmCRC) registry

Multidisciplinary management of colorectal brain metastases

Solitary Cerebellar Metastasis of Cecal Cancer, Visualized Using F-18 FDG PET/CT

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