Brain metastasis from colorectal cancer: a single center experience

Abstract

PurposeThe detection rate of brain metastasis (BM) from colorectal cancer (CRC) is increasing. This study was designed to analyze the clinical features of BM and prognosis according to the therapeutic modalities.MethodsA total of 19 cases were collected in this study between November 2008 and December 2015. We reviewed the patients' demographic data and the clinical features of BM retrospectively and investigated their prognostic significance.ResultsNineteen patients included 8 male and 11 female patients. The median age at diagnosis of BM was 62.4 years (range, 32–83 years). The median interval between diagnosis of CRC and BM was 39 months (range, 0–98 months). Eighteen patients (94.7%) had extracranial metastasis at the diagnosis of BM. Lung was the most common site of extracranial metastasis in 14 patients (73.7%). Synchronous BMs were found at the diagnosis of primary CRC in 2 patients (10.5%). The location of primary CRC was the colon in 6 patients (31.6%) and the rectum in 13 patients (68.4%). At the diagnosis of BM, 10 patients (52.6%) had a solitary BM. The common neurologic symptoms were headache in 8 cases (42.1%) and ataxia in 6 cases (31.6%). The median survival after the diagnosis of BM was 3 months (range, 1–10 months). The patients who underwent surgery plus stereotactic radiosurgery (SRS) had an improved survival (range, 3–10 months) than the other patients (range, 1–6 months) (P = 0.016).ConclusionIn patients with BM from CRC, surgical resection plus SRS might improve survival.

Brain metastasis in colorectal cancer presenting as refractory hypertension

“…In a recent study, Kim D-Y et al looked at 19 patients with BM in CRC. The common presenting symptoms were headache in 42.1% and ataxia in 31.6% of the patients [11]. Our patient presented with hypertensive urgency with headache which was refractory to treatment and with no focal neurological deficits.…”

Brain Metastases from Colorectal Cancer: A Systematic Review of the Literature and Meta-Analysis to Establish a Guideline for Daily Treatment

“…The initial symptoms of brain metastases were highly variable and were mostly not described in further detail. The most commonly reported symptoms were epileptic seizures, signs of increased intracranial pressure, or neurological symptoms [ 30 , 31 , 32 , 33 , 34 , 35 ]. Some patients did not show any symptoms at the time of diagnosis ( Table 3 ).…”

“…Some patients did not show any symptoms at the time of diagnosis ( Table 3 ). While Berghoff et al found a ratio of 96.8% of asymptomatic patients, Kim D. et al described only 5.3% of patients as being without symptoms [ 31 , 34 ]. Shindorf et al performed a study that screened patients with metastatic CRC for BM, regardless of whether neurological symptoms were present.…”

“…The smallest study population reported on five patients, while the largest study included 475 patients with BM. The analyzed studies are shown in Figure 6 and Table 7 [ 9 , 10 , 11 , 12 , 14 , 15 , 18 , 20 , 23 , 24 , 25 , 26 , 27 , 29 , 34 , 45 , 46 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ].…”

Brain and bone marrow metastases from rectal cancer

“…Indeed, it has been reported that both BM and breast metastases from rectal cancer are a sign of disseminated disease and chemotherapy alone may have a crucial role [8]. Moreover, several case reports of brain metastasis from colorectal cancer with a curative intent approach showed that a combination of local therapy—i.e., metastasectomy and/or whole brain radiotherapy or stereotactic radiosurgery—with systemic chemotherapy may have a role [9]. As far as breast metastasis treatment is concerned, there are only limited reports describing controversial strategies.…”