Multimodality management of brain metastasis from colorectal cancer.

Abstract

204 Background: More than 50% of colorectal cancer (CRC) patients will develop metastatic disease. Brain metastasis (BM) from colorectal cancer is uncommon (0.6-1.36%). This study aims to investigate the patient characteristics, treatment modalities and prognostic factors in this rare population. Methods: 104 patients with brain metastasis disease from CRC were identified from over 30,000 colorectal cancer patients at the Mayo Clinic Rochester between 1/1994 and 6/2019. A retrospective review was conducted by using data from electronic medical records (EMR). Statistical analysis utilized the Kaplan-Meier method, Log-rank test, and Cox proportional hazards models. Results: Among the 104 patients, 62 were male (59.6%) and 42 were female (40.4%). Median age at CRC diagnosis was 58.4 and at BM diagnosis was 61. Thirty-three patients had right-sided colon cancers, 27 patients had left-sided colon cancers and 39 patients had rectal cancer. Median time from CRC diagnosis to BM was 30.7 months. The majority of patients (58.7%) presented with a solitary brain lesion. Eighty-six patients (82.7%) had extracranial metastatic disease at BM diagnosis. Median survival was 7.0 months (95% CI 2.6-16.9) from BM diagnosis. Age <70, solitary BM, surgery, radiation, and chemotherapy were associated with statistically significant improved survival on univariate and multivariate analysis. Multi-modality treatment including surgical brain lesion resection, postoperative stereotactic radiation (SRS) with/without whole brain radiation (WBRT), and chemotherapy significantly improved median overall survival (Table). Conclusions: Although BM from CRC carries poor prognosis, multi-modality treatment (surgery, radiation and systemic chemotherapy) for patients with limited BM improves clinical outcome. [Table: see text]

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

“…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 ].…”

“…Two studies did not report the exact OS. Duan et al (>65 years: 4 months; <65 years: 10 months) and Quan et al (>60 years: 4 months; <60 years: 8 months) described a survival benefit from 4 to 6 months [ 7 , 55 , 57 , 64 ]. Five studies evaluated KPS as a risk factor for poor OS.…”

“…Four studies compared one BM with more than one BM, those of Lu et al (1: 9 months; >1: 5 months), Roussile et al (2018) (1: 6.3 months, >1: 3.1 months), Roussile et al (2016) (1: 12.3 months; >1: 4,9 months), and Gu et al (1: 10 months; >1: 6 months). Duan et al (1–2: 10 months; >2: 4 months), Sun et al (1–2: 8 months; >2: 4 months), and Imaizumi et al (1–3: 8.8 months; >3: 3.1 months) implemented different cut-offs [ 7 , 10 , 45 , 57 , 61 , 64 , 67 , 68 , 69 , 70 , 72 ]. Three studies reported that a positive CEA level was associated with a poor OS, but only Quan et al reported a survival benefit of 3 months in patients with negative CEA levels [ 7 , 27 , 55 ].…”

“…They investigated the influence of the treatment on the OS. Common therapies were radiation, surgery, chemotherapy, or a combination of the latter [ 9 , 14 , 25 , 26 , 27 , 34 , 54 , 57 , 61 , 62 , 64 , 67 , 68 , 70 , 73 , 74 , 84 , 85 ].…”

“…The best survival rates were reported in patients who were treated with neurosurgery with/without radiation or chemotherapy. Jin et al showed that a multimodal therapy regime resulted in a longer OS (41.1 months) ( Figure 7 and Figure 8 ) [ 57 ].…”