Colorectal cancer intracranial metastases outcome [Neurosurgery Wiki]

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====== Colorectal cancer intracranial metastases outcome ======

In addition to [[KPS]], the number of brain lesions and history of [[chemotherapy]] was independent prognostic factors for [[OS]] in patients with brain metastases from CRC. An awareness of these factors may help gastrointestinal surgeons make appropriate choices in the treatment of these patients
((Imaizumi J, Shida D, Narita Y, Miyakita Y, Tanabe T, Takashima A, Boku N,
Igaki H, Itami J, Kanemitsu Y. Prognostic factors of brain metastases from
colorectal cancer. BMC Cancer. 2019 Jul 31;19(1):755. doi:
10.1186/s12885-019-5973-x. PubMed PMID: 31366387; PubMed Central PMCID:
PMC6670227.
)).
----
Yang et al.  identified 170,793 adult patients diagnosed with CRC between 2010 and 2013. From these patients, they identified 401 patients with BM at the time of CRC diagnosis, which represents 0.23% of the entire patient CRC cohort and 1.3% of the patients with metastatic disease to any site. Median survival of patients with BM was 7.0 months, and the survival could increase to 15.59 months if there was no metastasis to other organs. We found that extracranial metastases number, tumor site, and pathology type were associated with BM at CRC diagnosis.

These findings lend support for positive treatment for BM without metastasis to other organs
((Yang L, He W, Xie Q, Liu S, Kong P, Jiang C, Zhang B, Xia L. Brain metastases 
in newly diagnosed colorectal cancer: a population-based study. Cancer Manag Res.
2018 Nov 15;10:5649-5658. doi: 10.2147/CMAR.S180173. eCollection 2018. PubMed
PMID: 30532587; PubMed Central PMCID: PMC6245349.
)).
----
In a retrospective study of 19 cases, the patients who underwent surgery plus stereotactic radiosurgery (SRS) had an improved survival (range, 3-10 months) than the other patients (range, 1-6 months) (P = 0.016)
((Kim DY, Ryu CG, Jung EJ, Paik JH, Hwang DY. Brain metastasis from colorectal
cancer: a single center experience. Ann Surg Treat Res. 2018 Jan;94(1):13-18.
doi: 10.4174/astr.2018.94.1.13. Epub 2017 Dec 28. PubMed PMID: 29333421; PubMed
Central PMCID: PMC5765273.
)).
----
Most patients with central nervous system involvement die from their extracranial disease
((Tapia Rico G, Price TJ, Karapetis C, Piantadosi C, Padbury R, Roy A, Maddern
G, Moore J, Carruthers S, Roder D, Townsend AR. Brain metastasis in advanced
colorectal cancer: results from the South Australian metastatic colorectal cancer
(SAmCRC) registry. Cancer Biol Med. 2017 Nov;14(4):371-376. doi:
10.20892/j.issn.2095-3941.2017.0068. PubMed PMID: 29372103; PubMed Central PMCID:
PMC5785167.
)).
----
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 
((Suzuki Y, Yamaguchi T, Matsumoto H, Nakano D, Honda G, Shinoura N, Karasawa K,
Takahashi K. Prognostic factors and treatment effects in patients with curatively
resected brain metastasis from colorectal cancer. Dis Colon Rectum. 2014
Jan;57(1):56-63. doi: 10.1097/01.dcr.0000436998.30504.98. PubMed PMID: 24316946.)).
----
In a study of Noura et al. the prognosis of patients with BM from CRC is associated with the curability of the therapy for BM and number of metastatic organs 
((Noura S, Ohue M, Shingai T, Fujiwara A, Imada S, Sueda T, Yamada T, Fujiwara Y, Ohigashi H, Yano M, Ishikawa O. Brain metastasis from colorectal cancer: prognostic factors and survival. J Surg Oncol. 2012)).
----
From 48 patients (25 men, 23 women) who developed brain metastases from CRC, they developed late in the course of the disease, given that most patients already have other secondary lesions. Prognosis in these patients is poor, with those receiving treatment with surgery and [[WBRT]] having the best overall survival. Early detection and treatment of brain metastases with new systemic therapies may improve outcomes
((Damiens K, Ayoub JP, Lemieux B, Aubin F, Saliba W, Campeau MP, Tehfe M.
Clinical features and course of brain metastases in colorectal cancer: an
experience from a single institution. Curr Oncol. 2012 Oct;19(5):254-8. doi:
10.3747/co.19.1048. PubMed PMID: 23144573; PubMed Central PMCID: PMC3457876.
)).

===== References =====