Brain metastasis in advanced colorectal cancer: Results from the South Australian metastatic colorectal cancer (SAmCRC) registry

Abstract

Objective: Brain metastasis is considered rare in metastatic colorectal cancer (mCRC); thus, surveillance imaging does not routinely include the brain. The reported incidence of brain metastases ranges from 0.6% to 3.2%. Methods:The South Australian mCRC Registry (SAmCRC) was analyzed to assess the number of patients presenting with brain metastasis during their lifetime. Due to small numbers, a descriptive analysis is presented. Results:Only 59 patients of 4,100 on the registry at the time of analysis had developed brain metastasis (1.4%). The clinical characteristics of those with brain metastasis were as follows: the median age was 65.3 years and 51% were female. Where the VKi-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation status of the tumor was known, the majority harbored a KRAS mutation (55%); 31 (53%) underwent craniotomy and 55 (93%) underwent whole-brain radiotherapy. The median survival time from diagnosis of brain metastasis was 4.2 months (95% confidence interval 2.9-5.5). Patients who underwent craniotomy and radiotherapy had superior survival compared to those who underwent whole-brain radiotherapy (8.5 months vs. 2.2 months, respectively). Data from the SAmCRC (a population-based registry) confirm that brain metastases are rare and the median time to development is approximately 2 years. Conclusions: Brain metastasis is a rare outcome in advanced CRC. Patients within the registry tended to be female, young in age, and harbored with higher rates of KRAS mutations. Whether routine surveillance brain scanning should be considered remains controversial given the relative rarity of developing brain metastases in mCRC and ultimately, most patients with central nervous system involvement die from their extracranial disease.

Brain metastasis from colorectal cancer: Treatment, survival, and prognosis

“…Overall, the prognosis for patients with BM from CRC is generally regarded as poor, and the median survival time is only a few months. [11,16,21,22] In this study, the median survival time was 7 months. Several studies found that the reliable factors predictive of a poor prognosis were recursive partitioning analysis class III, [18,23] KPS < 70, [10,11] diagnosis-specific graded prognostic assessment score: 0 to 1, [19] extracranial metastases, [13,24,25] treatment, [12,20,26,27] number of BMs, and the specific targeted therapy agents.…”

“…The survival time of patients with BM is quite poor, with a median survival of only 1 to 2 months without treatment. [3,16] In recent years, local treatments, such as several types of radiation (whole-brain radiotherapy [WBRT] and stereotactic radiosurgery), and neurosurgical resection have been widely applied to metastatic lesions. [5,13,[16][17][18][19] Previous research has shown that the blood-brain barrier blocks the passage of cytotoxic drugs, so the effect of chemotherapy is poor.…”

“…[3,16] In recent years, local treatments, such as several types of radiation (whole-brain radiotherapy [WBRT] and stereotactic radiosurgery), and neurosurgical resection have been widely applied to metastatic lesions. [5,13,[16][17][18][19] Previous research has shown that the blood-brain barrier blocks the passage of cytotoxic drugs, so the effect of chemotherapy is poor. Recent studies have shown that advances in multimodal treatments such as combinations of radiotherapy, chemotherapy, and targeted therapies have improved the prognosis of patients with unresectable CRC, with a median overall survival (OS) of 4 to 12 months.…”

Surgical excision and radiotherapy for brain metastasis from colorectal cancer: How frailty and comorbidity indices influence outcome

“…5,6 In recent studies, surgical excision of resectable colorectal cancer brain metastasis (CRCBM) has been increasingly reported to improve overall survival (OS). [7][8][9][10] Moreover, the survival of patients with all BM has been shown to be related to several patient characteristics, including age, presence of extracranial metastases, being underweight, and medical comorbidities. [10][11][12][13] Comorbidity indices, such as the Recursive Partitioning Analysis (RPA) class, the 5-item modified frailty index (MFI-5) and prognostic nutritional index (PNI), have been increasingly utilized in both oncological and neurosurgical practices to represent a comprehensive comorbidity status that aims to improve the prediction of prognosis.…”

Cetuximab plus XELOX show efficacy against brain metastasis from colorectal cancer: a case report

“…However, with advances in diagnostics and treatment techniques, the reported incidence increases to 9% [ 5 ]. Brain metastases are believed to occur by seeding of circulating tumor cells into the brain microvasculature; within this special microenvironment, tumor growth is encouraged and the penetration of systemic medical therapies is limited, this has been demonstrated in both clinical and preclinical studies [ 6–10 ]. BM from CRC is associated with dismal prognosis [ 1 , 11–13 ].…”