Abstract
Brain metastases from colorectal carcinoma (CRC) are rare. The objectives of this study are to assess the natural history, outcome, and possible prognostic factors in CRC patients with brain metastases. Between 1995 and 2008, 8,732 patients with CRC were treated at Yonsei University Health System. Brain metastases were found in 1.4% of these patients. Retrospective review and statistical analysis of these 126 patients were performed. Median time from diagnosis of metastatic CRC (mCRC) to brain metastases was 9.0 months (range 0–85 months), and 14 patients (11.1%) had brain involvement as their initial presentation. Among the 126 patients, 91.3% had other systemic metastases; the most common extracranial metastatic site was lung (72.2%). Median follow-up duration was 6.1 months (range 0.1–90.3 months), and median survival after diagnosis of brain metastases was 5.4 months [95% confidence interval (CI) 3.9–6.9 months]. Median survival time after diagnosis of brain metastases was 1.5 months for patients who received only steroids (15.9%), 4.0 months for those who received whole-brain radiation therapy (37.5%), 9.5 months for those who received gamma-knife surgery (GKS) (32.5%), and 11.5 months for those who underwent surgery (20%) (P < 0.001). On multivariate analysis, recursive partitioning analysis (RPA) class and amount of chemotherapy before brain metastasis were independent prognostic factors for survival. Overall prognosis of patients with brain metastases from CRC is poor. Nevertheless, patients with low RPA class, or those with previous less chemotherapy showed good prognosis, indicating that proper treatment may result in improved survival time.
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Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59:225–249
Floyd CE, Stirling CT, Cohn I (1966) Cancer of the colon, rectum and anus: review of 1,687 cases. Ann Surg 163:829–837
Cascino TL, Leavengood JM, Kemeny N, Posner JB (1983) Brain metastases from colon cancer. J Neurooncol 1:203–209
O’Neill BP, Iturria NJ, Link MJ, Pollock BE, Ballman KV, O’Fallon JR (2003) A comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases. Int J Radiat Oncol Biol Phys 55:1169–1176
Grothey A, Sargent D, Goldberg RM, Schmoll H (2004) Survival of patients with advanced colorectal cancer improves with the availability of fluorouracil-leucovorin, irinotecan, and oxaliplatin in the course of treatment. J Clin Oncol 22:1209–1214
van den Bent MJ (2001) The diagnosis and management of brain metastases. Curr Opin Neurol 14:717–723
Mehta MP et al (2003) Survival and neurologic outcomes in a randomized trial of motexafin gadolinium and whole-brain radiation therapy in brain metastases. J Clin Oncol 21:2529–2536
Ewend MG, Carey LA, Morris DE, Harvey RD, Hensing TA (2001) Brain metastases. Curr Treat Options Oncol 2:537–547
Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751
Hammoud MA, McCutcheon IE, Elsouki R, Schoppa D, Patt YZ (1996) Colorectal carcinoma and brain metastasis: distribution, treatment, and survival. Ann Surg Oncol 3:453–463
Fasola G et al (2009) Neurosurgical management and postoperative whole-brain radiotherapy for colorectal cancer patients with symptomatic brain metastases. J Cancer Res Clin Oncol 135:451–457
Balteskard L, Pawinski A, Nieder C (2009) Colorectal cancer metastatic to the brain: time trends in presentation and outcome. Oncology 76:369–374
Farnell GF, Buckner JC, Cascino TL, O’Connell MJ, Schomberg PJ, Suman V (1996) Brain metastases from colorectal carcinoma. The long term survivors. Cancer 78:711–716
Wroński M, Arbit E (1999) Resection of brain metastases from colorectal carcinoma in 73 patients. Cancer 85:1677–1685
Kruser TJ, Chao ST, Elson P, Barnett GH, Vogelbaum MA, Angelov L, Weil RJ, Pelley R, Suh JH (2008) Multidisciplinary management of colorectal brain metastases: a retrospective study. Cancer 113:158–165
Chyun Y, Hayward E, Lokich J (1980) Metastasis to the central nervous system from colorectal cancer. Med Pediatr Oncol 8:305–308
Cohen SJ, Wang H, Rogatko A, Meropol NJ, Sundermeyer ML (2005) Changing patterns of bone and brain metastases in patients with colorectal cancer. Clin Colorectal Cancer 5:108–113
Fowler A, Cook R, Biggs M, Little N, Assaad N, McDonald K (2008) Survival of patients following neurosurgical treatment of colorectal adenocarcinoma metastasis in the Northern Sydney-Central Coast area. J Clin Neurosci 15:998–1004
Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE (2004) Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol 22:2865–2872
Schouten LJ, Rutten J, Huveneers HA, Twijnstra A (2002) Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer 94:2698–2705
Lassman AB, DeAngelis LM (2003) Brain metastases. Neurol Clin 21:1–23, vii
Sundermeyer ML, Meropol NJ, Rogatko A, Wang H, Cohen SJ (2005) Changing patterns of bone and brain metastases in patients with colorectal cancer. Clin Colorectal Cancer 5:108–113
Kim TJ, Song S, Kim CK, Kim WY, Choi CH, Lee JH, Lee JW, Bae DS, Kim BG (2007) Prognostic factors associated with brain metastases from epithelial ovarian carcinoma. Int J Gynecol Cancer 17:1252–1257
Gaspar LE, Scott C, Murray K, Curran W (2000) Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys 47:1001–1006
Choi HJ, Cho BC, Sohn JH, Shin SJ, Kim SH, Kim JH, Yoo NC (2009) Brain metastases from hepatocellular carcinoma: prognostic factors and outcome: brain metastasis from HCC. J Neurooncol 91:307–313
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This work was supported by a Korea Science and Engineering Foundation (KOSEF) grant funded by the Ministry of Science and Technology (MOST) of Korea (R11-2000-082-02008-0).
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Jung, M., Ahn, J.B., Chang, J.H. et al. Brain metastases from colorectal carcinoma: prognostic factors and outcome. J Neurooncol 101, 49–55 (2011). https://doi.org/10.1007/s11060-010-0214-9
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DOI: https://doi.org/10.1007/s11060-010-0214-9