Abstract
Brain metastases from colorectal cancer (crc) are quite rare. Here, we review the characteristics, presentation, and clinical course of such patients at our institution. We reviewed the medical records of patients with brain metastases from crc treated during 2000-2009. Associations between patient, tumour characteristics, treatment modality, and survival were assessed using the Kaplan-Meier method. We identified 48 patients (25 men, 23 women) who developed brain metastases from crc. The median age at diagnosis of the brain metastases was 63 years (range: 37-84 years). In 23 of the patients (48%), the primary tumour occurred in the rectum. At diagnosis of brain metastases, 43 patients (90%) also had other systemic metastases (mainly pulmonary and hepatic). The median interval between diagnosis of the primary tumour and of the brain metastases was 24 months. Median survival after a diagnosis of brain metastasis from crc was 4 months (range: 1-13 months). We observed substantially better survival (13 months, p < 0.001) in patients treated with surgery followed by whole-brain radiotherapy (wbrt) than in those treated with radiotherapy or surgery alone. Sex, age, location and number of brain metastases, and timing of diagnosis did not affect survival. Brain metastases from crc develop late in the course of the disease, given that most patients already have other secondary lesions. Prognosis in these patients is poor, with those receiving treatment with surgery and wbrt having the best overall survival. Early detection and treatment of brain metastases with new systemic therapies may improve outcomes.
Highlights
Colorectal cancer is the third leading cause of cancer death in the Western world, accounting for approximately 140,000 new cases and more than 51,000 deaths in 2010 in the United States[1]
We identified 48 patients (25 men, 23 women) who developed brain metastases from crc
We observed substantially better survival (13 months, p < 0.001) in patients treated with surgery followed by whole-brain radiotherapy than in those treated with radiotherapy or surgery alone
Summary
Colorectal cancer (crc) is the third leading cause of cancer death in the Western world, accounting for approximately 140,000 new cases and more than 51,000 deaths in 2010 in the United States[1]. In Canada, crc is the fourth most-diagnosed neoplasm, and overall, the second leading cause of death from cancer. Even after complete resection of the colorectal tumour, distant metastases have been noted to develop in 10%–15% of patients. Of all metastases, those to liver are found in 20%–30% of cases, and to lung, in 10%–20%; brain metastases are quite rare[3,4]. Patients with brain metastases from crc have a shorter survival than do those with brain metastases originating from other primary tumours
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