Neurosurgical management and postoperative whole-brain radiotherapy for colorectal cancer patients with symptomatic brain metastases

Aprile, Giuseppe; Zanon, E.; Tuniz, Francesco; Iaiza, E.; Pauli, F. De; Pella, Nicoletta; Pizzolitto, Stefano; Buffoli, Alberto; Piga, Andrea; Škrap, Miran; Fasola, Gianpiero

doi:10.1007/s00432-008-0468-1

Cited by 45 publications

(43 citation statements)

References 35 publications

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“…Surgical resection of oligometastatic disease may produce survival benefits in suitable candidates (46)(47)(48). Our data suggest that KRAS mutation status may identify patients at increased risk of recurrence in the brain, but studies on larger patient cohorts will be required to formally show this association.…”

Section: Discussionmentioning

confidence: 88%

KRAS Mutation Is Associated with Lung Metastasis in Patients with Curatively Resected Colorectal Cancer

Tie

Lipton

Desai

et al. 2011

Clinical Cancer Research

201

169

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Purpose: Oncogene mutations contribute to colorectal cancer development. We searched for differences in oncogene mutation profiles between colorectal cancer metastases from different sites and evaluated these as markers for site of relapse.Experimental Design: One hundred colorectal cancer metastases were screened for mutations in 19 oncogenes, and further 61 metastases and 87 matched primary cancers were analyzed for genes with identified mutations. Mutation prevalence was compared between (a) metastases from liver (n ¼ 65), lung (n ¼ 50), and brain (n ¼ 46), (b) metastases and matched primary cancers, and (c) metastases and an independent cohort of primary cancers (n ¼ 604). Mutations differing between metastasis sites were evaluated as markers for site of relapse in 859 patients from the VICTOR trial.Results: In colorectal cancer metastases, mutations were detected in 4 of 19 oncogenes: BRAF (3.1%), KRAS (48.4%), NRAS (6.2%), and PIK3CA (16.1%). KRAS mutation prevalence was significantly higher in lung (62.0%) and brain (56.5%) than in liver metastases (32.3%; P ¼ 0.003). Mutation status was highly concordant between primary cancer and metastasis from the same individual. Compared with independent primary cancers, KRAS mutations were more common in lung and brain metastases (P < 0.005), but similar in liver metastases. Correspondingly, KRAS mutation was associated with lung relapse (HR ¼ 2.1; 95% CI, 1.2 to 3.5, P ¼ 0.007) but not liver relapse in patients from the VICTOR trial.Conclusions: KRAS mutation seems to be associated with metastasis in specific sites, lung and brain, in colorectal cancer patients. Our data highlight the potential of somatic mutations for informing surveillance strategies.

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Section: Discussionmentioning

confidence: 88%

KRAS Mutation Is Associated with Lung Metastasis in Patients with Curatively Resected Colorectal Cancer

Tie

Lipton

Desai

et al. 2011

Clinical Cancer Research

201

169

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“…None of our patients received stereotactic radiotherapy and just half underwent surgical resection. Surgery combined with WBRT is proven to be the most effective treatment for isolated CRC brain metastasis in patients who are ideal surgical candidates [10][11][12]26 . Farnell 28 , for instance, published interesting work looking at the survival rates of 150 mCRC patients treated with different treatment modalities and determining the main characteristics in long-term survivors.…”

Section: Discussionmentioning

confidence: 99%

“…Many affected patients will suffer considerable loss of autonomy due to neurocognitive and functional deficits, as well as morbidity associated with steroids and anticonvulsants. Only a small number of patients who can have surgical resection with or without postoperative wholebrain radiotherapy (WBRT) are considered, with more encouraging outcomes [median overall survival (mOS) of approximately 8 months] [10][11][12] . Over the last few years, stereotactic radiosurgery has become another treatment modality with outcomes appearing to be comparable to those of surgical resection for patients with oligometastases that are small and present minimal mass effects.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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“…However, the incidence of metastases to the brain is on the increase, due to effective therapies for CRC, which have provided longer survival times, and more effective neuroimaging techniques. The genesis and treatment of brain metastases from CRC has therefore attracted attention (16,17). We also reviewed CRC patient records between 2001 and 2008 in Huashan Hospital.…”

Section: Discussionmentioning

confidence: 99%

microRNA expression profiles in human colorectal cancers with brain metastases

Fang

et al. 2011

Oncology Letters

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Abstract. The present study aimed to identify microRNA (miRNA) expression profiles associated with brain metastases of colorectal cancers. We conducted miRNA expression profiling of 3 primary colorectal cancers and 3 brain-metastatic carcinomas using Agilent Human miRNA Microarrays. Quantitative real-time reverse transcription-polymerase chain reaction (RT-PCR) was employed to validate the results obtained from the miRNA microarray analysis. Overexpression of miR-145, miR-1, miR-146a, miR-576-5p, miR-126*, HS287, miR-28-5p, miR-143, miR-199b-5p, miR-199a-5p, miR-10b, miR-22, miR-133b, miR-145*, miR-199a, miR-133a, miR-125b and downregulation of miR-31 and HS170 were observed in brain-metastatic carcinomas. Quantitative RT-PCR experiments with miR-125b confirmed the expression patterns we found in our microarray experiments. miRNAs are differentially expressed between colorectal cancers and matched brain-metastatic carcinomas. The miRNA variation trend is quite different in the process of metastasis compared to that of carcinogenesis. These miRNAs may therefore serve as potential diagnostic markers and therapeutic targets for colorectal cancers with brain metastases.

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Neurosurgical management and postoperative whole-brain radiotherapy for colorectal cancer patients with symptomatic brain metastases

Abstract: Neurosurgical management of symptomatic brain metastases from colorectal cancer is feasible, relatively safe, and offers a chance of prolonged survival. Patients who received radiotherapy after resection experienced a better outcome.

Cited by 45 publications

References 35 publications

KRAS Mutation Is Associated with Lung Metastasis in Patients with Curatively Resected Colorectal Cancer

KRAS Mutation Is Associated with Lung Metastasis in Patients with Curatively Resected Colorectal Cancer

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

microRNA expression profiles in human colorectal cancers with brain metastases

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