Treatment modalities and relative survival in patients with brain metastasis from colorectal cancer

Abstract

Colorectal cancer (CRC) metastatic to the brain occurs rarely and remains highly lethal in clinical practice. The crude incidence of brain metastases (BM) from CRC is 0.27%, while in metastatic colorectal cancer, it increases to 1.36% (1). Besides, the occurrence rate of asymptomatic BM has been observed to increase simultaneously in past decades (2), which has been attributed to the improvement of multimodality therapy to extend survival of CRC and novel diagnostic radiographic techniques to detect small brain lesions (3,4). Unfortunately, the prognosis for CRC patients developed to BM is rather poor. Patients without any therapeutic intervention will only have a survival period of about 4 weeks after the occurrence of BM (5). In the past, whole brain radiation therapy (WBRT) and neurosurgery were usually used for the treatment of brain metastases (6), but the effect of radiotherapy or neurosurgery alone was unsatisfactory. Patients who underwent WBRT alone had a median survival of only 3-6 months (7,8), and the ability of neurosurgery to improve survival in patients with BM is not as effective as clinicians expected. Currently, the concept of multidisciplinary treatment has been widely accepted in the clinical diagnosis and treatment of CRC liver metastasis and lung metastasis (9,10), and proved that multidisciplinary treatment could bring significant survival benefits to those patients. Nevertheless, in CRC patients with BM, the concept of multidisciplinary treatment was not universal. The decision-making for treatment modalities is still empirical in patients with Summary Standard treatment options for brain metastases (BM) from colorectal cancer (CRC) are controversial. The purpose of this study was to evaluate the efficacy of multidisciplinary treatment modalities and provide optimal therapeutic strategies for selected patients with different clinical characteristics. All eligible patients diagnosed with BM from CRC during the past two decades (1997-2016) were identified in our center. Clinical characteristics, treatment modalities and relative survival were retrospectively analyzed. Median overall survival after the identification of BM was 6 months. The 1-and 2-year survival rates were 29.40% and 5.70%, respectively. On multivariate analysis, the number of BMs, Karnofsky performance score and the treatment modalities were found to be independent prognostic factors (the p-value was 0.006, 0.001 and < 0.001, respectively). In conclusion, multidisciplinary treatment is supported to be the optimal treatment for patients with BM from CRC. For patients with single brain metastases and KPS > 70, neurosurgery combined with chemotherapy could provide an additional survival benefit. For patients with multiple brain metastases or KPS ≤ 70, radiotherapy plus chemotherapy may be appropriate.

Survival Outcome of Surgical Resection vs. Radiotherapy in Brain Metastasis From Colorectal Cancer: A Meta-Analysis

“…As shown in Table 1 , a total of 17 retrospective cohort studies ( 4 , 8 , 11 – 13 , 15 , 25 – 35 ), involving 1,438 patients with CRC BM were included. Among the 17 studies, 11 ( 4 , 8 , 12 , 13 , 25 – 27 , 29 , 30 , 32 , 34 ) studies clearly pointed out the radiation modalities with either WBRT or RS, whereas the remaining 6 ( 11 , 15 , 28 , 31 , 33 , 35 ) did not.…”

Primary Tumor Resection Provides Survival Benefits for Patients with Synchronous Brain Metastases from Colorectal Cancer

“…CRC patients with synchronous BMs may have a different prognosis risk than those with metachronous BMs. Patients with CRC BMs with a KPS score > 70 had a 4–7 months survival benefit over those with a KPS score < 70 [ 50 , 51 , 52 ]. Radiation, surgery, chemotherapy, or a combination of the three were the most prevalent treatments for BMs.…”

Radiotherapy guidelines for rectal cancer in China (2020 Edition)

“…The treatment of rectal cancer brain metastasis includes surgical resection, stereotactic radiotherapy, and whole brain radiotherapy. The treatment plan is based on the number and location of brain metastases, whether there are extracranial metastases, and the general condition of the patient 63 …”

“…The treatment plan is based on the number and location of brain metastases, whether there are extracranial metastases, and the general condition of the patient. 63…”