Results of Whole Brain Radiation Therapy in Patients with Brain Metastases from Colorectal Carcinoma

Abstract

Aims and background Carcinoma of the colon-rectum is an infrequent cause of brain metastases, constituting 1-5% of all metastatic lesions to the brain. We reviewed our experience in the treatment of brain metastases from colorectal cancer to define the efficacy of whole brain radiation therapy as a palliative measure in this setting of patients. Methods Twenty-three consecutive cases of brain metastasis from colorectal cancer treated between 1999 and 2004 were identified in the files of the Division of Radiotherapy of the A Businco Regional Oncological Hospital, Cagliari. Their records were reviewed for patient and tumor characteristics and categorized according to the RTOG RPA classes. Results Fifteen patients (65%) had multiple metastases. Twenty-one patients (91%) showed extracranial metastases. Fourteen patients were classified as RTOG RPA class II and 9 class III. The median radiation dose delivered was 2000 cGy in 5 fractions in one week (range, 20-36 Gy). In 14 of 20 assessable patients (70%), symptomatic improvement was observed. The median follow-up and survival time for all the patients, 12 females and 11 males, was 3 months. In 3 patients only the cause of death was the brain metastasis. Conclusions Despite the disappointing survival time, external radiation therapy to the whole brain proved to be an efficacious palliative treatment for patients with multiple or inoperable brain metastasis from colorectal cancer.

Brain metastases from colorectal carcinoma: a description of 60 cases in a single Chinese cancer center

“…The RPA class has been suggested to be an independent prognostic factor for patients with many types of BM [11,26], including BM from CRC [8,9,21,27]. In line with previous studies, the survival of patients in RPA class I/II was greater in the present study.…”

Prognostic Factors for Patients With Advanced Colorectal Cancer and Symptomatic Brain Metastases

“…This result is consistent with previous studies, which report MSTs ranging from 2.4 to 7.4 months. 1,14,15,17,25 We further observed that, in all 25 patients, the diagnosis of BMs was prompted by symptoms of neurological disorder. Most of the patients with BMs had undergone systemic chemotherapy as treatment for extracerebral metastases, especially lung or liver metastases.…”

Neurosurgical management and postoperative whole-brain radiotherapy for colorectal cancer patients with symptomatic brain metastases

“…At present, whilst external radiotherapy may be a realistic option to palliate unresectable brain lesions in CRC patients (Amichetti et al 2005), its role after local therapy, either SRS or surgical resection, remains uncertain. Whether additional WBRT is beneWcial after surgery in terms of survival or quality of life is currently under study, although there is some data suggesting a trend towards improved outcomes (Patchell et al 1998).…”