Single-fraction SRS and multiple-fraction SRT for brain metastases from colorectal cancer

Abstract

ObjectiveBrain metastasis from colorectal cancer (CRC) is rare. Although stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) are effective treatments for brain metastasis, reports on brain metastasis of CRC are limited. This study compared the efficacy of SRT and SRS for the treatment of brain metastases from CRC and analysed the related factors to reveal the specificity CRC-derived brain metastasis.MethodsA retrospective analysis of 116 patients with brain metastases from colorectal cancer was performed and included 56 patients in the SRT group and 60 patients in the SRS group. The clinical characteristics of the two groups were analysed, and the local tumour control rate, overall survival time and radiation-induced brain injury were compared between the two groups.ResultsThe objective response rates of the SRT and SRS groups were 76.8% and 66.7%, respectively, while the local control rates at 6 months were 87.5% and 81.6%, respectively, and no significant differences were observed between the groups (P=0.295). The median overall survival time was 10.3 months for all patients and was 10.9 months in the SRT group and 9.8 months in the SRS group, with no significant difference between the groups (P=0.123). A multivariate analysis showed that the main factors of poor prognosis were low GPA score (P=0.002), KRAS mutation (P=0.035), extracranial metastasis (P=0.005) and no bevacizumab treatment (P=0.001). No significant difference was observed in the incidence of acute and late radiation-induced injury between the two groups.ConclusionBoth SRT and SRS are effective methods for the treatment of CRC-derived brain metastases. The simultaneous use of bevacizumab may be one of the most important factors that affects the survival of these patients.

Cost of Treatment for Brain Metastases Using Data From a National Health Insurance Provider

“…In addition, a recent study comparing overall survival in patients receiving SRS or SRT for treatment of BMs found a nonsignificant difference in survival time between the 2 treatment strategies. 12 Considering our discovery that SRT has a higher average per-treatment cost than both GK SRS and LINAC SRS, and given that no significant differences in acute and late radiation-induced injury between the 2 fractionation methods has been observed, 13 further scrutiny is warranted to assess the clinical preference for SRT over SRS. One possible justification for using SRT over SRS is that SRS is typically used for lesions under 3 cm in diameter, while SRT becomes advisable when the tumor is larger or near critical structures like optic nerves.…”

Gastrointestinal Kanserlerden Gelişen Beyin Metastazı Olan Hastalarda Stereotaktik Radyocerrahiye Yanıtın ve Sağkalım Sonuçlarının Değerlendirilmesi

“…[23] In larger series involving 93 and 116 colorectal cancer patients, the median OS was found to be 7 and 10.3 months, respectively. [24,25] In the study of Yamomota et al [19] , which has the highest number of patients on this subject, it is thought that those with lower gastrointestinal cancer had a longer survival than those with upper gastrointestinal cancer (5.9 months vs. 4.8 months), but this finding was not statistically significant. In our study, we found that upper and lower gastrointestinal cancers were similar in terms of patient and treatment parameters; we did not detect a statistically significant difference between the two groups.…”

Five-Fraction Radiosurgery Using a Biologically Equivalent Dose of a Single Fraction of 24 Gy for a 3-cm Parasagittal Para-Central Sulcus Brain Metastasis From Adenocarcinoma of the Cecum

“…After switching from CPT-11 to L-OHP, the radiation effects improved, suggesting that CPT-11 may have exacerbated the radiation injury. Moreover, the addition of BEV was highly effective, facilitating early discontinuation of steroids and leading to minimal perilesional edema [ 5 , 17 , 18 ]. If BEV had been introduced early after SRS, it might have precluded AREs and enhanced the anti-tumor efficacy of the BM.…”

“…A 68-year-old, right-handed male, with a Karnofsky performance status of 100%, underwent laparoscopic right hemicolectomy for cecal cancer that was detected by screening, which resulted in non-curative resection of the lymph node metastases and disseminated nodules involving the para-aortic major vessels, including ileocolic artery and superior mesenteric artery/vein. The pathological examination revealed moderately differentiated, mainly tubular and partly mucinous, adenocarcinoma, harboring Kirsten rat sarcoma viral oncogene (KRAS) G12D mutation while the other biomarkers, including a serine/threonine-protein kinase B-Raf (BRAF) mutation and microsatellite instability, were negative [ 1 , 4 , 5 ]. Due to the rapid progression of the unresectable lesions, the patient subsequently received adjuvant chemotherapy, in which bevacizumab (BEV) was excluded, considering the risk of hemorrhage from the vessel-involving lesions.…”

“…However, the incidence of BMs from CRC is anticipated to occur, owing to improved survival of patients with locally advanced or metastatic CRC, driven by ongoing advancement of systemic therapy [1]. Even in recent reports, the prognosis of patients harboring CRC BMs generally remains dismal, with a median survival of 5-10 months [2][3][4][5][6]. In addition, right-sided CRC (including the appendix, cecum, and ascending colon) is associated with an unfavorable prognosis, compared with left-sided CRC (including the descending colon, sigmoid, and rectum) [7].…”