Colorectal Cancer Metastatic to the Brain: Time Trends in Presentation and Outcome

Abstract

Objective: It was the aim of this study to compare differences in disease pattern, patient characteristics and survival in patient cohorts treated during different decades. Methods: We conducted a retrospective analysis of all patients with brain metastases from colorectal cancer treated between 1983 and June 2008 in Northern Norway. The patients were assigned to 3 different groups, based on the decade of treatment. Results: The time interval between first cancer diagnosis and brain metastases has significantly increased over time. The use of chemotherapy before development of brain metastases has also increased. Only few patients did not harbour extracranial metastases. Chemotherapy after diagnosis of brain metastases has been used exclusively in the present decade, but in only 3 patients. Combined surgical resection or radiosurgery plus whole-brain radiotherapy has increasingly been utilized, but whole-brain radiotherapy alone remained the cornerstone. Neither survival from first cancer diagnosis nor from brain metastasis treatment has improved significantly; however, with up to 17 patients, the groups were small. Three factors were significantly associated with better survival: good performance status, limited number of brain metastases (1 vs. 2–3 vs. 4 or more) and absence of extracranial metastases. The prognostic impact of the recursive partitioning analysis classes was confirmed, while the new graded prognostic assessment index performed less well. Conclusions: Median survival was maximum 6 months in all decades, despite the increasing use of more aggressive treatment. As most patients harbour extracranial metastases that threaten their lives, systemic treatment might theoretically play a role in the management of these patients, but more data need to be collected to confirm the clinical impact of this approach.

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

“…It is thought that the incidence of brain metastases recorded from all solid tumors has steadily increased over the last two decades due to the increase in survival of patients, better radiological diagnostic methods, and in particular, the widespread use of magnetic resonance imaging (MRI) to detect small metastases. However, in the specific case of CRC, the incidence seems to have remained somewhat unchanged, as supported by the outcome of our analysis 5,14 . Brain metastases in mCRC are generally associated with advanced stage and most diagnoses of CNS secondaries are metachronous.…”

Clinical Features and Course of Brain Metastases in Colorectal Cancer: An Experience from a Single Institution

“…Current treatment recommendations for brain metastases from crc do not differ from those for brain primaries 6 . Until recently, the use of chemotherapy to treat central nervous system metastases has been unsatisfactory.…”

“…Whole-brain radiotherapy alone is the most common therapeutic modality administered; however, it is associated with the worst prognosis (the survival rate ranges from 2.2 months to 4 months). Surgical interventions have been shown to improve survival to 6-10 months [5][6][7] . Unfortunately, identification of the predictors of survival in the literature is still equivocal.…”

“…With improvements in the management of colorectal tumours, the incidence of metastases at previously uncommon sites is suspected to rise 6 . Previously, the treatment offered for brain metastases was essentially directed at palliating neurologic symptoms.…”

Stereotactic Radiosurgery in Treatment of Cerebral Metastases: Histological Differences in Predictors of Survival

“…A review of the histology specific literature reveals a wide variation within different histological subtypes, making generalizing any staging criteria difficult [6,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. To our knowledge, there are five studies (including the current study) reporting outcomes of brain metastasis from breast primaries with a study size of at least 100 patients [6,8,21,25].…”