Brain Metastasis from Colorectal Cancer: Predictors and Treatment Outcomes

Abstract

Objective: Difficulties are associated with the management of brain metastasis (BM), which portends a poor prognosis in the treatment of colorectal cancer (CRC). The aim of the present study was to identify risk factors for BM in CRC and evaluate the outcomes of various treatment modalities. Methods: We retrospectively reviewed data on a total of 2,238 patients with primary CRC who underwent surgical resection at our hospital between 1999 and 2014. Predictive factors for BM and prognostic factors after the diagnosis of BM were examined by univariate and multivariate analyses using Cox proportional hazards models. Results: Three patients (0.1%) had BM at the initial diagnosis, and 23 patients (1.2%) developed metachronous BM during the median follow-up period of 44.6 months. Lung and bone metastases were identified as independent predictive factors for BM. Median survival after the diagnosis of BM was 7.4 months. Stereotactic radiosurgery, administered to 41% of the patients with BM, was associated with a better postdiagnostic survival. Conclusion: CRC patients with metastasis to the lung or bone were at a higher risk of BM. Because the survival is still limited, it is crucial to determine the treatment strategy in consideration of the characteristics of each therapy and quality of life in CRC patients with BM.

Bone metastasis predicts poor prognosis of patients with brain metastases from colorectal carcinoma post aggressive treatment

“… 2 – 5 The risk of subsequent metastasis to the brain increases once CRC cells metastasize to the lung and bone. 3 Moreover, CRC patients with limited involvement of lung or liver exhibit improved outcomes, whereas those with tumors with a predilection for spreading to the bone or brain tissue have worse outcomes. 6 Therefore, CRC patients with brain metastasis (BM) are usually viewed as in the terminal stage with a dismal prognosis.…”

“…Recently, the incidence of BM in CRC patients was found to be increasing, although higher frequency screening and expanded management options for advanced CRC have improved patient survival. 3 , 7 Many studies have been performed to explore clinic–pathologic and aberrant molecular features in CRC patients at high risk of developing BM. 3 , 7 In general, the prognosis of CRC patients with BM is very poor, with median overall survival (OS) ranging from 1 to 6 months, 2 , 7 – 11 which is significantly shorter than that in patients with other types of primary malignancies.…”

Vision Loss from Metastatic Colon Cancer to the Planum Sphenoidale and Optic Nerves

“…Large-scale retrospective review of colorectal adenocarcinoma cases from multiple sites reveal a 0.1%-4% incidence of brain metastases. 1,2 Brain metastases usually have a poor prognosis with usually less than 9 month life expectancy. 1,2 The most common presenting symptom is headache, and surgical resection produces the best survival outcome.…”

“…1,2 Brain metastases usually have a poor prognosis with usually less than 9 month life expectancy. 1,2 The most common presenting symptom is headache, and surgical resection produces the best survival outcome. 1,2 Colon cancer metastases causing vision loss is extremely rare, with only case reports mentioning metastasis to the optic nerve, 3 parasellar region, 4,5 and to a pituitary adenoma.…”

“…1,2 The most common presenting symptom is headache, and surgical resection produces the best survival outcome. 1,2 Colon cancer metastases causing vision loss is extremely rare, with only case reports mentioning metastasis to the optic nerve, 3 parasellar region, 4,5 and to a pituitary adenoma. 6 Although metastases to the anterior visual pathways are a rare cause of vision loss, new reduction of vision, changes in extraocular motility or visual field defects 7 and new endocrine abnormalities such as secondary hypothyroidism or diabetes insipidus 8 should increase suspicion and initiate imaging to look for compressive aetiologies.…”