Where Are We Now and Where Might We Be Headed in Understanding and Managing Brain Metastases in Colorectal Cancer Patients?

Mjahed, Ribal Bou; Astaras, Christoforos; Roth, Arnaud; Koessler, Thibaud

doi:10.1007/s11864-022-00982-0

Cited by 12 publications

(9 citation statements)

References 111 publications

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“…Future efforts in the management of brain metastases from GI primaries aim at earlier detection and molecular characterization for personalized selection of systemic agents. 26 Liquid biopsy for profiling of circulating tumor cells may detect KRAS or BRAF mutations, which have been found in higher incidences in brain metastases from GI primaries vs primary tissue. Personalization of systemic therapy also continues to advance, including HER2-directed therapies such as trastuzumab-emtansine for esophageal adenocarcinoma extrapolating from patients with breast cancer, encorafenib for patients with BRAF mutations that has previously shown efficacy in melanoma patients, and poly (ADP-ribose) polymerase inhibitors for colorectal cancer patients with BRCA mutations that induce synthetic lethality and theoretically improve the therapeutic ratio of radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis

et al. 2023

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BACKGROUND: There are limited data regarding outcomes for patients with gastrointestinal (GI) primaries and brain metastases treated with stereotactic radiosurgery (SRS). OBJECTIVE: To examine clinical outcomes after SRS for patients with brain metastases from GI primaries and evaluate potential prognostic factors. METHODS: The International Radiosurgery Research Foundation centers were queried for patients with brain metastases from GI primaries managed with SRS. Primary outcomes were local control (LC) and overall survival (OS). Kaplan-Meier analysis was used for univariate analysis (UVA) of prognostic factors. Factors significant on UVA were evaluated with a Cox multivariate analysis proportional hazards model. Logistic regressions were used to examine correlations with RN. RESULTS: We identified 263 eligible patients with 543 brain metastases. Common primary sites were rectal (31.2%), colon (31.2%), and esophagus (25.5%) with a median age of 61.6 years (range: 37-91.4 years) and a median Karnofsky performance status (KPS) of 90% (range: 40%-100%). One-year and 2-year LC rates were 83.5% (95% CI: 78.9%-87.1%) and 73.0% (95% CI: 66.4%-78.5%), respectively. On UVA, age >65 years (P = .001), dose <20 Gy (P = .006) for single-fraction plans, KPS <90% (P < .001), and planning target volume ≥2cc (P = .007) were associated with inferior LC. All factors other than dose were significant on multivariate analysis (P ≤ .002). One-year and 2-year OS rates were 68.0% (95% CI: 61.5%-73.6%) and 31.2% (95% CI: 24.6%-37.9%), respectively. Age > 65 years (P = .006), KPS <90% (P = .005), and extracranial metastases (P = .05) were associated with inferior OS. CONCLUSION: SRS resulted in comparable LC with common primaries. Age and KPS were associated with both LC and OS with planning target volume and extracranial metastases correlating with LC and OS, respectively. These factors should be considered in GI cancer patient selection for SRS.

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Section: Discussionmentioning

confidence: 99%

Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis

et al. 2023

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Cheng

Chen

et al. 2022

Diagnostics

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Background: Brain metastases (BMs), particularly synchronous brain metastases, in colorectal cancer (CRC) patients are uncommon. The survival benefit of primary tumor resection (PTR) in patients with metastatic colorectal cancer is controversial. Whether PTR can bring survival benefits to patients with BMs of CRC has not been reported. Methods: From 2010 to 2016, 581 CRC patients with BMs from the Surveillance, Epidemiology, and End Results (SEER) database were divided into PTR and non-PTR groups. The log-rank test was used to compare the survival distributions. The Kaplan-Meier method was used to estimate survival. By controlling additional prognostic factors, a Cox proportional multivariate regression analysis was used to estimate the survival benefit of PTR. Results: The median overall survival for CRC patients with synchronous BMs was 3 months, with a 1-year survival rate of 27.2% and a 2-year survival rate of 12.8%. The PTR group contained 171 patients (29.4%), whereas the non-PTR group had 410 patients (70.6%). Patients who underwent PTR had a 1-year survival rate of 40.2% compared to 21.7% in those who did not (p < 0.0001). Cox proportional analysis showed that patients ≥60 years (hazard ratio [HR] 1.718, 95% confidence interval [CI] 1.423–2.075, p < 0.0001) had a shorter OS than patients < 60 years of age. OS was better in CEA-negative than in CEA-positive patients (HR 0.652, 95% CI 0.472–0.899, p = 0.009). Patients in whom the primary tumor was removed had considerably improved prognoses (HR 0.654, 95% CI 0.531–0.805, p < 0.0001). Subgroup analysis revealed that the PTR group achieved a survival advantage except for patients with CEA negative. Conclusions: Patients with synchronous BMs from CRC may benefit from primary tumor resection (PTR). Age, CEA level, and PTR were independent prognostic risk factors for CRC patients with synchronous BMs.

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“…The presence of brain metastasis indicates late-stage CRC, as 36.6–68% of patients have liver metastasis and 71–92% of patients have lung involvement ( 9 ). The median survival of these patients after symptomatic treatment is only 4-6 weeks, whereas their survival after systemic chemotherapy is approximately 6-9 months ( 10 , 11 ).…”

Section: Discussionmentioning

confidence: 99%

Single-fraction SRS and multiple-fraction SRT for brain metastases from colorectal cancer

Li¹,

Wu²,

Li³

et al. 2022

Front. Oncol.

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ObjectiveBrain metastasis from colorectal cancer (CRC) is rare. Although stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) are effective treatments for brain metastasis, reports on brain metastasis of CRC are limited. This study compared the efficacy of SRT and SRS for the treatment of brain metastases from CRC and analysed the related factors to reveal the specificity CRC-derived brain metastasis.MethodsA retrospective analysis of 116 patients with brain metastases from colorectal cancer was performed and included 56 patients in the SRT group and 60 patients in the SRS group. The clinical characteristics of the two groups were analysed, and the local tumour control rate, overall survival time and radiation-induced brain injury were compared between the two groups.ResultsThe objective response rates of the SRT and SRS groups were 76.8% and 66.7%, respectively, while the local control rates at 6 months were 87.5% and 81.6%, respectively, and no significant differences were observed between the groups (P=0.295). The median overall survival time was 10.3 months for all patients and was 10.9 months in the SRT group and 9.8 months in the SRS group, with no significant difference between the groups (P=0.123). A multivariate analysis showed that the main factors of poor prognosis were low GPA score (P=0.002), KRAS mutation (P=0.035), extracranial metastasis (P=0.005) and no bevacizumab treatment (P=0.001). No significant difference was observed in the incidence of acute and late radiation-induced injury between the two groups.ConclusionBoth SRT and SRS are effective methods for the treatment of CRC-derived brain metastases. The simultaneous use of bevacizumab may be one of the most important factors that affects the survival of these patients.

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Where Are We Now and Where Might We Be Headed in Understanding and Managing Brain Metastases in Colorectal Cancer Patients?

Cited by 12 publications

References 111 publications

Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis

Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis

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

Single-fraction SRS and multiple-fraction SRT for brain metastases from colorectal cancer

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