Skip to main content

Advertisement

SpringerLink
Log in

Brain metastases from colorectal carcinoma: a description of 60 cases in a single Chinese cancer center

  • Research Article
  • Published:
Tumor Biology

Abstract

The incidence of brain metastasis (BM) from colorectal carcinoma (CRC) is increasing. The objectives of the present study were to explore the clinical characteristics and potential prognostic factors in CRC patients with BM. Between April 1991 and December 2010, all CRC patients treated in the Sun Yat-sen University Cancer Center were retrospectively reviewed and 60 patients were identified to have BM (36 males and 24 females). The association between patients and their tumor characteristics, treatment modality, and survival were statistically analyzed. The median age at diagnosis of BM was 62.5 years. Fifty-three patients (88.3%) developed extracranial metastases at diagnosis of BM. The cause of death was systemic disease in 19 patients and neurological disease in 23 patients. Brain metastases were primarily treated with either whole brain radiation therapy (WBRT; 15 patients), stereotactic radiosurgery (SRS; nine patients), or surgical resection (seven patients). Ten patients received WBRT and SRS, and 19 patients (31.7%) were treated with steroids alone. The median survival after diagnosis of BM was 8 months (95% confidence interval = 4.2–11.8 months). Recursive partitioning analysis (RPA) class, the number of brain lesions, and treatment modality type were significantly associated with survival. Although BM from CRC is a late-stage phenomenon with an extremely poor prognosis, some subsets of patients would benefit from a multidisciplinary management strategy. A low RPA class and a limited number of brain lesions may predict increased survival after therapy for CRC patients with BM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.

    Article  PubMed  Google Scholar 

  2. Li M, Gu J. Changing patterns of colorectal cancer in china over a period of 20 years. World J Gastroenterol. 2005;11:4685–8.

    PubMed  Google Scholar 

  3. Gavrilovic IT, Posner JB. Brain metastases: epidemiology and pathophysiology. J Neurooncol. 2005;75:5–14.

    Article  PubMed  Google Scholar 

  4. Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010;77:655–61.

    Article  PubMed  Google Scholar 

  5. Wronski M, Arbit E. Resection of brain metastases from colorectal carcinoma in 73 patients. Cancer. 1999;85:1677–85.

    Article  PubMed  CAS  Google Scholar 

  6. Cascino TL, Leavengood JM, Kemeny N, Posner JB. Brain metastases from colon cancer. J Neurooncol. 1983;1:203–9.

    Article  PubMed  CAS  Google Scholar 

  7. Go PH, Klaassen Z, Meadows MC, Chamberlain RS. Gastrointestinal cancer and brain metastasis: a rare and ominous sign. Cancer. 2011. doi:10.1002/cncr.25940.

  8. Jung M, Ahn JB, Chang JH, Suh CO, Hong S, Roh JK, et al. Brain metastases from colorectal carcinoma: prognostic factors and outcome. J Neurooncol. 2011;101:49–55.

    Article  PubMed  Google Scholar 

  9. Kruser TJ, Chao ST, Elson P, Barnett GH, Vogelbaum MA, Angelov L, et al. Multidisciplinary management of colorectal brain metastases: a retrospective study. Cancer. 2008;113:158–65.

    Article  PubMed  Google Scholar 

  10. Farnell GF, Buckner JC, Cascino TL, O’Connell MJ, Schomberg PJ, Suman V. Brain metastases from colorectal carcinoma. The long term survivors. Cancer. 1996;78:711–6.

    Article  PubMed  CAS  Google Scholar 

  11. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, et al. Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997;37:745–51.

    Article  PubMed  CAS  Google Scholar 

  12. Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322:494–500.

    Article  PubMed  CAS  Google Scholar 

  13. Mongan JP, Fadul CE, Cole BF, Zaki BI, Suriawinata AA, Ripple GH, et al. Brain metastases from colorectal cancer: risk factors, incidence, and the possible role of chemokines. Clin Colorectal Cancer. 2009;8:100–5.

    Article  CAS  Google Scholar 

  14. Schouten LJ, Rutten J, Huveneers HA, Twijnstra A. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer. 2002;94:2698–705.

    Article  PubMed  Google Scholar 

  15. Ko FC, Liu JM, Chen WS, Chiang JK, Lin TC, Lin JK. Risk and patterns of brain metastases in colorectal cancer: 27-year experience. Dis Colon Rectum. 1999;42:1467–71.

    Article  PubMed  CAS  Google Scholar 

  16. Tan WS, Ho KS, Eu KW. Brain metastases in colorectal cancers. World J Surg. 2009;33:817–21.

    Article  PubMed  Google Scholar 

  17. Pramateftakis MG, Hatzigianni P, Kanellos D, Vrakas G, Kanellos I, Agelopoulos S, et al. Brain metastases in colorectal cancer. Tech Coloproctol. 2010;14 Suppl 1:S67–8.

    Article  PubMed  Google Scholar 

  18. Bartelt S, Momm F, Weissenberger C, Lutterbach J. Patients with brain metastases from gastrointestinal tract cancer treated with whole brain radiation therapy: prognostic factors and survival. World J Gastroenterol. 2004;10:3345–8.

    PubMed  Google Scholar 

  19. Lagerwaard FJ, Levendag PC, Nowak PJ, Eijkenboom WM, Hanssens PE, Schmitz PI. Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys. 1999;43:795–803.

    Article  PubMed  CAS  Google Scholar 

  20. Heisterkamp C, Haatanen T, Schild SE, Rades D. Dose escalation in patients receiving whole-brain radiotherapy for brain metastases from colorectal cancer. Strahlenther Onkol. 2010;186:70–5.

    Article  PubMed  Google Scholar 

  21. Meyners T, Heisterkamp C, Kueter JD, Veninga T, Stalpers LJ, Schild SE, et al. Prognostic factors for outcomes after whole-brain irradiation of brain metastases from relatively radioresistant tumors: a retrospective analysis. BMC Cancer. 2010;10:582.

    PubMed  Google Scholar 

  22. Matsunaga S, Shuto T, Kawahara N, Suenaga J, Inomori S, Fujino H. Gamma knife surgery for brain metastases from colorectal cancer. Clinical article. J Neurosurg. 2011;114:782–9.

    Article  PubMed  Google Scholar 

  23. Fowler A, Cook R, Biggs M, Little N, Assaad N, McDonald K. Survival of patients following neurosurgical treatment of colorectal adenocarcinoma metastasis in the northern Sydney–central coast area. J Clin Neurosci. 2008;15:998–1004.

    Article  PubMed  CAS  Google Scholar 

  24. Gaspar LE, Mehta MP, Patchell RA, Burri SH, Robinson PD, Morris RE, et al. The role of whole brain radiation therapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2010;96:17–32.

    Article  PubMed  Google Scholar 

  25. Cunningham D, Humblet Y, Siena S, Khayat D, Bleiberg H, Santoro A, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med. 2004;351:337–45.

    Article  PubMed  CAS  Google Scholar 

  26. Gaspar LE, Scott C, Murray K, Curran W. Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys. 2000;47:1001–6.

    Article  PubMed  CAS  Google Scholar 

  27. Amichetti M, Lay G, Dessi M, Orru S, Farigu R, Orru P, et al. Results of whole brain radiation therapy in patients with brain metastases from colorectal carcinoma. Tumori. 2005;91:163–7.

    PubMed  Google Scholar 

  28. Nieder C, Pawinski A, Balteskard L. Colorectal cancer metastatic to the brain: time trends in presentation and outcome. Oncology-Basel. 2009;76:369–74.

    Google Scholar 

  29. Kalkanis SN, Kondziolka D, Gaspar LE, Burri SH, Asher AL, Cobbs CS, et al. The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2010;96:33–43.

    Article  PubMed  Google Scholar 

  30. Aprile G, Zanon E, Tuniz F, Iaiza E, De Pauli F, Pella N, et al. Neurosurgical management and postoperative whole-brain radiotherapy for colorectal cancer patients with symptomatic brain metastases. J Cancer Res Clin Oncol. 2009;135:451–7.

    Article  PubMed  Google Scholar 

  31. Linskey ME, Andrews DW, Asher AL, Burri SH, Kondziolka D, Robinson PD, et al. The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2010;96:45–68.

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Sun Yat-sen University Cancer Center, No. 651, Dong Feng Road E., Guangzhou, 510060, People’s Republic of China

    Xiao-Bing Jiang, Qun-Ying Yang, Ke Sai, Xiang-Heng Zhang, Zhong-Ping Chen & Yong-Gao Mou

Authors
  1. Xiao-Bing Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qun-Ying Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ke Sai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiang-Heng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhong-Ping Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yong-Gao Mou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong-Gao Mou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jiang, XB., Yang, QY., Sai, K. et al. Brain metastases from colorectal carcinoma: a description of 60 cases in a single Chinese cancer center. Tumor Biol. 32, 1249–1256 (2011). https://doi.org/10.1007/s13277-011-0229-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13277-011-0229-7

Keywords

Search

Navigation