Epidemiology and Outcomes of Patients With Brain Metastases From Colorectal Cancer-Who Are These Patients?

Renata Colombo Bonadio; Guilherme Fialho Freitas; Daniel Negrini Batista; Otavio Augusto Noschang Moreira; Carla A R Dias; Tiago Biachi Castria; Jorge Sabbaga; Paulo M Hoff

doi:10.1016/j.clcc.2021.04.002

Epidemiology and Outcomes of Patients With Brain Metastases From Colorectal Cancer-Who Are These Patients?

Clin Colorectal Cancer. 2021 Sep;20(3):e195-e200. doi: 10.1016/j.clcc.2021.04.002. Epub 2021 Apr 15.

Authors

Renata Colombo Bonadio¹, Guilherme Fialho Freitas², Daniel Negrini Batista³, Otavio Augusto Noschang Moreira³, Carla A R Dias³, Tiago Biachi Castria⁴, Jorge Sabbaga⁴, Paulo M Hoff²

Affiliations

¹ Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Instituto D'Or de Ensino e Pesquisa, São Paulo Brazil. Electronic address: rrccbonadio@gmail.com.
² Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Instituto D'Or de Ensino e Pesquisa, São Paulo Brazil.
³ Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.
⁴ Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Hospital Sírio Libanês, São Paulo, Brazil.

PMID: 33966961
DOI: 10.1016/j.clcc.2021.04.002

Abstract

Background: Brain metastases (BMs) from colorectal cancer (CRC) are unusual; however, an increase in incidence has been reported. The evidence available on the subject is scarce, and a better understanding is warranted. We aimed to characterize the epidemiology and the outcomes of patients with BMs from CRC.

Patients and methods: A cohort of patients with BMs from CRC was retrospectively evaluated. Patients were treated in a single center between May 2008 and April 2019. BMs were confirmed by brain computed tomography or magnetic resonance imaging.

Results: A total of 247 consecutive patients were evaluated. Most patients had a left-sided primary tumor (193, 78%) and at least two extra-cranial metastatic sites (194, 78%). Ninety-six patients (39%) were RAS wild-type; 68 patients (27%) were RAS mutated; and 83 patients (34%) were not characterized. Median time from the initial diagnosis to BMs was 27.6 months (interquartile range, 13.1-46.9). Regarding local therapy, 43 patients (17.4%) were treated with BM surgery alone, 76 patients (30.8%) with radiotherapy (RT) alone, and 58 patients (23.5%) with both surgery and RT. Median overall survival (OS) was 2.9 months (95% confidence interval [CI], 2.2-3.5). Six-month and 1-year OS rates were 29% (95% CI, 23-25) and 13.5% (95% CI, 9.2-18.6), respectively. In a multivariable analysis, BM surgery alone (hazard ratio [HR], 0.56; P = .018), RT alone (HR, 0.51; P = .001), and surgery plus RT (HR, 0.27; P < .001) were associated with superior OS, whereas Eastern Cooperative Oncology Group Performance Status 3 or 4 (HR, 2.01; P = .009) and male gender (HR, 1.46; P = .012) were negative prognostic factors. RAS status was not associated with OS.

Conclusion: BMs occur late during the course of colorectal cancer and are more common in patients with a left-sided primary tumor and a high volume of metastatic disease. BMs from colorectal cancer are still associated with an extremely poor prognosis; however, selected patients may benefit from treatment with surgical resection and radiotherapy.

Keywords: Central nervous system; Local therapy; Molecular; Radiotherapy; Surgery.

MeSH terms

Brain Neoplasms* / epidemiology
Colorectal Neoplasms* / epidemiology
Colorectal Neoplasms* / therapy
Humans
Male
Prognosis
Radiosurgery*
Retrospective Studies