Multidisciplinary management of colorectal brain metastases

Abstract

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.

Colorectal Cancer Metastatic to the Brain: Time Trends in Presentation and Outcome

“…In line with previous reports, the current series confirms that concomitant extracerebral metastases are a very common finding [10,11,12,13,14,15] and that the median age of the patients is 61–66 years [10,15,16,17,18]. The initial intention of the authors was to perform this analysis in the same way they evaluated time trends in the treatment of brain metastases from breast cancer [3].…”

“…Therefore, it might be prudent to analyse the performance of the well-known prognostic scores, RPA and GPA, in patients with colorectal cancer brain metastases. Kruser et al [10] and Amichetti et al [14] did not confirm the prognostic impact of the RPA classes, while Fowler et al [17] and the present study did. As illustrated in figure 4, survival of patients with a poor performance status (RPA class III) is very limited.…”

“…from the small sample size. Other publications coherently described median intervals between 2 and 3 years [10, 13,16,17,18,19,20], including a study from the 1980s [11]. …”

“…Brain metastases from colorectal cancer are less common than from malignant melanoma, lung and breast cancer, but their impact on prognosis is equally serious [8,9,10]. In line with previous reports, the current series confirms that concomitant extracerebral metastases are a very common finding [10,11,12,13,14,15] and that the median age of the patients is 61–66 years [10,15,16,17,18].…”

Clinical features and course of brain metastases in colorectal cancer: Experience from a single institution.

“…Those originating from a colorectal primary are relatively rare, with a reported incidence ranging from 1% to 4% 9,10 study showed the 5-year cumulative incidence of brain metastases to be approximately 16%, 10%, 7%, and 5% for patients with lung cancer, renal cell cancer, melanoma, and breast cancer respectively; brain metastases accounted for fewer than 1% of metastases in crc 11 . Although brain metastases from crc are less common than those from malignant melanoma and lung and breast cancer, their effect on prognosis is equally serious 12 . Most brain metastases from solid tumours result from hematogenous spread rather than from dissemination via cerebrospinal fluid.…”