Abstract
Background
The aim of our study is to evaluate the outcome of patients affected by brain metastases from colorectal cancer and to correlate the outcome with prognostic factors.
Methods
Patients were retrospectively evaluated. Survival distributions were estimated by using the Kaplan–Meier method. The log-rank test was used to assess the impact on survival of individual factors.
Results
Among 41 patients (25M and 16F; median age 58), 58.5 % had rectal cancer and 39 % synchronous metastatic disease; 95 % had extracranial metastases, most common site was lung (87.8 %). Seven patients had synchronous brain metastases. Median overall survival after diagnosis of brain metastases was 5 months [95 % confidence interval 3–12 months]. Median survival from brain metastases diagnosis was 4.2 months in patients treated with radiotherapy (29.3 %), 11.9 months in those with radio- and chemotherapy (21.9 %) and 21.4 months in those with surgery with/without radiotherapy or chemotherapy (29.3 %) (P < 0.0001). On multivariate analysis, no independent prognostic factors were found for disease-free interval from diagnosis to brain metastases and overall survival; amount of chemotherapy before brain metastases have no statistically significant relation to brain-metastases-free-interval even if patients who received more than one line of chemotherapy have a longer median brain-metastases-free-interval than those who received less than one. KRAS was found mutated in 17/28 patients without statistically significant correlation to outcome due to the small sample size.
Conclusions
Prognosis of brain-metastases-patients is poor. An interesting tool is to evaluate the correlation of KRAS status and brain metastases with aim to tailor treatment and follow-up.
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References
Hammoud MA, McCutcheon IE, Elsouki R, Schoppa D, Patt YZ (1996) Colorectal carcinoma and brain metastasis: distribution, treatment and survival. Ann Surg Oncol 5:453–463
Alden TD, Gianino JW, Saclarides TJ (1996) Brain metastases from colorectal cancer. Dis Colon Rectum 39(5):541–545
Wronski M, Arbit E (1999) Resection of brain metastases from colorectal carcinoma in 73 patients. Cancer 85(8):1677–1685
Nieder C, Pawinski A, Balteskard L (2009) Colorectal cancer metastatic to the brain: time trends in presentation and outcome. Oncology 76:369–374
Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Rad Oncol Biol Phys 37:745–751
Jung M, Ahn JB, Chang JH et al (2011) Brain metastases from colorectal carcinoma: prognostic factors and outcome. J Neurooncol 101:49–55
Krueser TJ, Chao ST, Elson P et al (2008) Multidisciplinary management of colorectal brain metastases: a retrospective study. Cancer 113(1):158–165
Morovic JA, Chang SD (2011) Literature review of various treatment plans and outcomes for Brain Metastases from colorectal cancer. World Neurosurg 79(3–4):435–436
Farnell GF, Buckner JC, Cascino TL, O’Connell MJ, Schomberg PJ, Suman V (1996) Brain metastases from colorectal carcinoma. The long term survivors. Cancer 78:711–716
Baek JY, Kang MH, Hong YS et al (2011) Characteristics and prognosis of patients with colorectal cancer-associated brain metastases in the era of modern systemic chemotherapy. J Neurooncol 104(3):745–753
Tajima Y, Ishibashi K, Ishiguro T et al (2009) Analysis of 12 cases of brain metastasis from colorectal cancer. Gan No Rinsho 36(12):2245–2247
Mongan JP, Fadul CE, Cole BF et al (2009) Brain metastases from colorectal cancer: risk factors, incidence, and the possible roles of chemokines. Clin Colorectal Cancer 8(2):100–105
Tie J, Lipton L, Desai J et al (2011) KRAS mutation is associated with lung metastasis in patients with curatively resected colorectal cancer. Clin Cancer Res 17:1122–1130
Acknowledgments
We thank Dr. Laura Adamoli for the data management.
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None declared
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Magni, E., Santoro, L., Ravenda, P.S. et al. Brain metastases from colorectal cancer: main clinical factors conditioning outcome. Int J Colorectal Dis 29, 201–208 (2014). https://doi.org/10.1007/s00384-013-1781-y
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DOI: https://doi.org/10.1007/s00384-013-1781-y