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 1).
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 2).
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) 3).
Most patients with central nervous system involvement die from their extracranial disease 4).
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 5).
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 6).
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 7).