Prognostic Factors and Treatment Effects in Patients With Curatively Resected Brain Metastasis From Colorectal Cancer

Abstract

Neurosurgical resection in select patients is a reasonable option for brain metastasis from colorectal cancer, although it is not associated with long-term (5-year) survival. (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A121 ).

Prognostic Factors for Patients With Advanced Colorectal Cancer and Symptomatic Brain Metastases

“…20,26,27 Previous studies show that neurological resection is a significant prognostic factor for BMs of CRC. 17,19 Neurosurgical resection is generally accepted as therapy for patients with single BMs. In previous studies of BMs from CRC, the incidence of solitary brain lesions was 31% to 64%, [15][16][17] and various series report 15.9% to 58.6% rates of resection.…”

“…The local recurrence rate for neurological resection is relatively high 19,30 ; earlier diagnosis of BMs, potentially when they are fewer in number, could increase the fraction of cases in which surgical resection and/or SRS are suitable and is expected to confer survival benefits. In addition, if BMs were detected before they resulted in neurological symptoms, interruptions to systemic chemotherapy might be avoided.…”

“…In previous studies of patients with BMs from CRC, various potential prognostic factors have been identified, including the number of BMs, 17,19-21 extracerebral metastases, [19][20][21] the interval between diagnoses of CRC and BMs, 15,16,20 RPA class, 21,22 BMs curability, 17 treatment modalities used for BMs, 19 and carcinoembryonic antigen (CEA) levels. 17 However, in light of recent advances in chemotherapeutic regimens for CRC, including cytotoxic drugs and molecular-targeted agents, it might be necessary to reevaluate these previously identified prognostic factors.…”

Brain metastases from colorectal cancer: characteristics and management

“…The most frequent favourable clinical prognostic factors were high Karnofsky score (≥70), low recursive partitioning analysis classes (I or II), the lack of extracranial disease and low number of BMs (<2) …”

“…Among treatment modalities, surgery alone or combined with WBRT were associated with the best prognosis. In two series, high dose of WBRT has also been identified as prognostic factor …”