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A systematic review to assess the management of patients with cerebral metastases secondary to colorectal cancer

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Abstract

Background

Colorectal cancer (CRC) rarely metastasizes to the brain. The incidence of cerebral metastases (CM) is estimated between 1 and 3%. Given the improved survival from advanced CRC as a result of surgical and oncological advances, it is anticipated that the incidence of patients with CM from CRC will rise over the next few years. The aim of this article was to systematically review the treatment options and outcome of patients with CM from CRC.

Methods

PubMed and Medline databases were examined using the search words or MESH headings “colorectal” “cancer/carcinoma/adenocarcinoma”, “cerebral”/”brain” and “metastases/metastasis”.

Results

CM from CRC are diagnosed on average 28.3 months after the primary tumour. The median survival time following diagnosis is 5.3 months. Surgery (with or without associated radiotherapy), stereotactic radiosurgery, whole brain radiotherapy and best supportive care result in median survival of 10.3, 6.4, 4.4 and 1.8 months, respectively. On average, the 1-year overall survival rate for patients with CM from CRC regardless of the treatment modality is estimated to be around 24%.

Conclusions

The prognosis of patients with CM from CRC is dismal. Surgery may increase survival, but the additional benefit of perioperative radiotherapy cannot be ascertained due to paucity of data. Further studies are required to identify the role of the different oncological and surgical therapies and identify those patients likely to benefit most. Identification of patients who are at higher risk of developing brain metastases may be another important area for future research.

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Authors’ contribution

All authors contributed to the literature review and the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Whittington Hospital, London, UK

    I. L. Silva & C. Bhan

  2. Department of Surgery, The Royal London Hospital, London, UK

    M. Iskandarani & A. Hotouras

  3. Department of Surgery, St Mary’s Hospital, Imperial College London, London, UK

    J. Murphy

  4. Department of Neurological Surgery, Cleveland Clinic Florida, Fort Lauderdale, FL, USA

    B. Adada

  5. Digestive Disease Center, Cleveland Clinic Florida, Fort Lauderdale, FL, USA

    S. D. Wexner

  6. National Centre for Bowel Research and Surgical Innovation, Barts and the London, School of Medicine and Dentistry, 2 Newark Street, London, E12AT, UK

    A. Hotouras

Authors
  1. I. L. Silva
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  2. M. Iskandarani
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  3. A. Hotouras
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  4. J. Murphy
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  5. C. Bhan
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  6. B. Adada
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  7. S. D. Wexner
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Corresponding author

Correspondence to A. Hotouras.

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The authors declare that they have no conflict of interest.

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The review has been conducted according to accepted principles of ethical and professional conduct.

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Silva, I.L., Iskandarani, M., Hotouras, A. et al. A systematic review to assess the management of patients with cerebral metastases secondary to colorectal cancer. Tech Coloproctol 21, 847–852 (2017). https://doi.org/10.1007/s10151-017-1707-8

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  • DOI: https://doi.org/10.1007/s10151-017-1707-8

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