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Brain metastases in colorectal cancer: prognostic factors and survival analysis

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Abstract

Purpose

Colorectal cancer (CRC) brain metastases (BM) are an uncommon and late event. We aim to investigate the impact of clinical factors, treatment modalities and RAS/BRAF status on the outcomes of CRC patients with BM.

Patients

We retrospectively analysed CRC patients who developed BM in our centre between January 1997 and June 2017. Clinical factors, treatment modalities, RAS/BRAF status and survival were evaluated.

Results

Twenty-eight patients were recorded; 82% had left-sided (LS) CRC and 71% had lung metastases. Median time to BM diagnosis was 36 months (m) and 93% of patients received local treatment of BM (43% whole brain radiotherapy, 50% surgery). Right-sided (RS) CRC showed shorter time to BM, not previously described (9.3 vs 46.6 m for RS and LS CRC, respectively; HR = 4.7, p = 0.006). Median overall survival (mOS) from BM treatment was 9.5 m, better in patients who underwent surgery than those treated with radiotherapy alone (12.1 vs 4.6 m, respectively; HR = 0.3, p = 0.019) and in those without progressive metastatic extracranial disease (7.2 vs 20.9 m, for progressive and non-progressive, respectively; HR = 0.3, p = 0.056). Patients with two or more metastatic extracranial locations showed worse prognosis (5.9 vs 16.3 m, for > 2 vs 0–1, respectively; HR = 3.7, p = 0.015). RAS/BRAF status did not showed prognostic value.

Conclusions

Time to BM diagnosis is shorter in RS CRC. The presence of two or more metastatic extracranial locations and progressive metastatic extracranial disease at the time of BM diagnosis could be bad prognosis factors for CRC BM patients.

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Author notes

  1. Luis Paul del Carpio Huerta and Maria Tobeña Puyal contributed equally to this work.

Authors and Affiliations

  1. Medical Oncology Department, Santa Creu i Sant Pau Hospital, Mas Casanovas, 90., 08025, Barcelona, Spain

    Luis Del Carpio Huerta, Anna Cristina Virgili Manrique, Marta Martin-Richard, David Paez Lopez-Bravo, Ana Sebio Garcia, Paula Gomila Pons, Marta Andres Granyo, Andres Barba Joaquin, Agusti Barnadas Molins & Maria Tobeña Puyal

  2. Pathology Department, Santa Creu i Sant Pau Hospital, Mas Casanovas, 90., 08025, Barcelona, Spain

    Justyna Szafranska & Iñigo Espinosa Mariscal

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  1. Luis Del Carpio Huerta
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Correspondence to Luis Del Carpio Huerta or Maria Tobeña Puyal.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Del Carpio Huerta, L., Virgili Manrique, A.C., Szafranska, J. et al. Brain metastases in colorectal cancer: prognostic factors and survival analysis. Int J Colorectal Dis 33, 1517–1523 (2018). https://doi.org/10.1007/s00384-018-3107-6

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