Stereotactic radiation therapy of brain metastases from colorectal cancer: A single institution cohort

Paix, A.; Antoni, D.; Adeduntan, R.; Noël, Georges

doi:10.1016/j.canrad.2017.01.010

Cited by 8 publications

(7 citation statements)

References 23 publications

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“… 2 , 7 – 11 , 13 Through the use of multidisciplinary disease management and aggressive treatment, patient survival is improving. 4 , 5 , 14 , 17 As reported previously, the median OS of all patients in the present study was 7.0 months. The OS of patients treated aggressively was dramatically longer than the OS in those treated conservatively (14.1 months vs 2.0 months, P <0.0001); this confirms that the nature of the treatment modality influences the prognosis of CRC patients with BM.…”

Section: Discussionsupporting

confidence: 84%

“…Patients with a limited number of BM and better performance status tended to receive aggressive treatment, including surgical resection, radiotherapy, and the combination of them, which has been shown to improve prognosis. 3 , 9 , 14 , 17 Our study provides further convincing evidence to support the role of the number of BM and performance status in determining treatment strategy.…”

Section: Discussionsupporting

confidence: 65%

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Bone metastasis predicts poor prognosis of patients with brain metastases from colorectal carcinoma post aggressive treatment

Duan

Guo

et al. 2018

CMAR

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PurposeThe presence of brain metastasis (BM) in patients with colorectal cancer (CRC) is usually associated with terminal-stage illness; however, a subgroup of patients receiving aggressive treatment can have a satisfactory prognosis. This study was designed to investigate the profile of prognostic factors in CRC patients with BM treated aggressively.Patients and methodsCRC patients with BM were retrospectively reviewed. Survival analysis was performed to identify potential prognostic factors in the entire cohort of patients and a subgroup of patients treated aggressively. Aggressive treatments included surgical resection, radiotherapy, and/or chemotherapy. Overall survival was defined as the time between the diagnosis of BM and death or until the date of the last follow-up visit.ResultsA total of 78 CRC patients were confirmed as having BM. Sixty-eight of them had extracranial metastases at the time of their BM diagnosis. The most common sites of extracranial metastases were lung (n=51, 65.4%), followed by liver (n=25, 32.1%) and bone (n=12, 15.4%). Fifty-one patients who were treated aggressively had significantly longer overall survival than those who accepted palliative care (14.1 months vs 2.0 months, P<0.0001). Multivariate analysis was applied, and the results showed that aggressive treatment (n=51), recursive partitioning analysis class I/II (hazard ratio [HR]=0.27, 95% CI: 0.12–0.6, P=0.001), and fewer BM (HR=0.4, 95% CI: 0.21–0.78, P=0.07) predicted longer survival. In contrast, the presence of bone metastasis, rather than lung or liver metastasis, at the time of diagnosis of BM (HR=2.38, 95% CI: 1.08–5.28, P=0.032) predicted a poor prognosis.ConclusionsAlthough the prognosis of CRC patients having BM is frequently very poor, those with good performance status and few brain lesions responded to aggressive treatment, while those with bone metastasis at the time of diagnosis of BM had relatively dismal survival rates, even when treated aggressively.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 65%

Bone metastasis predicts poor prognosis of patients with brain metastases from colorectal carcinoma post aggressive treatment

Duan

Guo

et al. 2018

CMAR

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“…19 SBRT/SRS has allowed the use of much higher doses of radiation for diverse tumor sites including brain, bone, lung, and liver. 1,23,25,27,29,32,[39][40][41] Compared to conventionally fractionated radiotherapy, the ablative doses used in SBRT/SRS can provide improved local control and palliation of symptoms. A recent phase II trial of 160 patients with nonspine bone lesions compared single-fraction SBRT using doses of 12-16 Gy in 1 fraction with conventionally fractionated radiotherapy (30 Gy in 10 fractions).…”

Section: Discussionmentioning

confidence: 99%

“…14,15,42,46 There has been concern that metastases from gastrointestinal (GI) cancers are particularly radioresistant and have poorer local control despite high-dose irradiation. 5,32 In this study, we assessed the outcomes of patients who underwent SRS for GI spinal metastases at our institution and hypothesized that spinal metastases from a GI origin have high rates of local failure (LF). We also determined factors associated with LF.…”

mentioning

confidence: 99%

Local control and toxicity outcomes of stereotactic radiosurgery for spinal metastases of gastrointestinal origin

Sandhu¹,

Benson²,

Kumar

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEColorectal cancer (CRC) and other gastrointestinal (GI) cancers are believed to have greater radioresistance than other histologies. The authors report local control and toxicity outcomes of stereotactic radiosurgery (SRS) to spinal metastases from GI primary cancers.METHODSA retrospective single-center review was conducted of patients with spinal metastases from GI primary cancers treated with SRS from 2004 to 2017. Patient demographics and lesion characteristics were summarized using medians, interquartile ranges (IQRs), and proportions. Local failure (LF) was estimated using the cumulative incidence function adjusted for the competing risk of death and compared using Gray’s test for equality. Multivariable analyses were conducted using Cox proportional hazard models, adjusting for death as a competing risk, on a per-lesion basis. Patients were stratified in the Cox model to account for repeated measures for clustered outcomes. Median survival was calculated using the Kaplan-Meier method.RESULTSA total of 74 patients with 114 spine lesions were included in our analysis. The median age of the cohort was 62 years (IQR 53–70 years). Histologies included CRC (46%), hepatocellular carcinoma (19%), neuroendocrine carcinoma (13%), pancreatic carcinoma (12%), and other (10%). The 1- and 2-year cumulative incidence rates of LF were 24% (95% confidence interval [CI] 16%–33%) and 32% (95% CI 23%–42%), respectively. Univariable analysis revealed that older age (p = 0.015), right-sided primary CRCs (p = 0.038), and single fraction equivalent dose (SFED; α/β = 10) < 20 Gy (p = 0.004) were associated with higher rates of LF. The 1-year cumulative incidence rates of LF for SFED < 20 Gy10 versus SFED ≥ 20 Gy10 were 35% and 7%, respectively. After controlling for gross tumor volume and prior radiation therapy to the lesion, SFED < 20 Gy10 remained independently associated with worse LF (hazard ratio 2.92, 95% CI 1.24–6.89, p = 0.014). Toxicities were minimal, with pain flare observed in 6 patients (8%) and 15 vertebral compression fractures (13%).CONCLUSIONSSpinal metastases from GI primary cancers have high rates of LF with SRS at a lower dose. This study found that SRS dose is a significant predictor of failure and that prescribed SFED ≥ 20 Gy10 (biological equivalent dose ≥ 60 Gy10) is associated with superior local control.

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“…Paix et al, evaluating 15 patients underwent SRS or HSRS, showed a 6 and 12 months LC rates of 78 and 52%, respectively, without Grade III toxicity or more. 34 Matzunaga et al reported a series of 154 patients treated with SRS. The 2 years local tumor control, defined as suppression of tumor growth, was 60% without impairment of patients quality of life (QOL).…”

Section: Discussionmentioning

confidence: 99%

Brain metastases from primary colorectal cancer: is radiosurgery an effective treatment approach? Results of a multicenter study of the radiation and clinical oncology Italian association (AIRO)

Navarria

Minniti

Clerici

et al. 2020

BJR

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Objectives: The prognosis of brain metastatic colorectal cancer patients(BMCRC) is poor. Several local treatments have been used, but the optimal treatment choice remains an unresolved issue. We evaluated the clinical outcomes of a large series of BMCRC patients treated in several Italian centers using stereotactic radiosurgery(SRS). Methods: One-hundred-eighty-five BMCRC patients for a total of 262 lesions treated were evaluated. Treatments included surgery followed by postoperative SRS to the resection cavity, and SRS, either single-fraction, then hypofractionated SRS(HSRS). Outcomes was measured in terms of local control(LC), toxicities, brain distant failure(BDF), and overall survival(OS). Prognostic factors influencing survival were assed too. Results: The median follow-up time was 33 months(range 3–183 months). Surgery plus SRS have been performed in 28 (10.7%) cases, SRS in 141 (53.8%), and HSRS in 93 (35.5%). Seventy-seven(41.6%) patients received systemic therapy. The main total dose and fractionation used were 24 Gy in single fraction or 24 Gy in three daily fractions. Local recurrence occurred in 32 (17.3%) patients. Median,6months,1-year-LC were 86 months(95%CI36-86), 87.2% ± 2.8, 77.8% ± 4.1. Median,6months,1-year-BDF were 23 months(95%CI9-44), 66.4% ± 3.9, 55.3% ± 4.5. Median,6months,1-year-OS were 7 months(95% CI 6–9), 52.7% ± 3.6, 33% ± 3.5. No severe neurological toxicity occurred. Stage at diagnosis, Karnofsky Performance Status (KPS), presence and number of extracranial metastases, and disease-specific-graded-prognostic-assessment (DS-GPA) score were observed as conditioning survival. Conclusions: SRS/HSRS have proven to be an effective local treatment for BMCRC. A careful evaluation of prognostic factors as well as a multidisciplinary evaluation is a valid aid to manage the optimal therapeutic strategy for CTC patients with BMs. Advances in knowledge: The prognosis of brain metastatic colorectal cancer patients (BMCRC) is poor. Several local treatments was used, but optimal treatment choice remains undefined. Radiosurgery has proven to be an effective local treatment for BMCRC. A careful evaluation of prognostic factors and a multidisciplinary evaluation needed.

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Stereotactic radiation therapy of brain metastases from colorectal cancer: A single institution cohort

Cited by 8 publications

References 23 publications

Bone metastasis predicts poor prognosis of patients with brain metastases from colorectal carcinoma post aggressive treatment

Bone metastasis predicts poor prognosis of patients with brain metastases from colorectal carcinoma post aggressive treatment

Local control and toxicity outcomes of stereotactic radiosurgery for spinal metastases of gastrointestinal origin

Brain metastases from primary colorectal cancer: is radiosurgery an effective treatment approach? Results of a multicenter study of the radiation and clinical oncology Italian association (AIRO)

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