Prognostic factors for survival in colorectal cancer patients with brain metastases undergoing whole brain radiotherapy: multicenter retrospective study

Taeryool Koo,Eui Kyu Chie,Kyubo Kim,Kyu Joo Park,Seung-Yong Jeong,Sae-Won Han,Tae-You Kim,Hae Jin Park

doi:10.1038/s41598-020-61354-y

Abstract

Whole brain radiotherapy (WBRT) is a mainstay of the treatment for brain metastases (BM). We evaluated prognostic factors in colorectal cancer (CRC) patients undergoing WBRT for BM. The medical records of 106 CRC patients undergoing WBRT for BM between 2000 and 2014 at three institutions were reviewed. Patient and tumor factors were analyzed to identify the prognostic factors for overall survival (OS) calculated from the date of BM diagnosis to the date of death or last follow-up. Surgical resection of BM was performed in six patients. The dose of WBRT was 30 Gy, and boost radiotherapy or stereotactic radiosurgery (8–23 Gy) was given to 15 patients. Systemic therapy for BM was administered in one patient before WBRT and 26 patients after WBRT. The median follow-up time was 3.9 months (range, 0.4–114.1 months). The median OS time was 3.9 months, and the 1-year OS rate was 18.2%. Older age (>65 years), multiple BM (≥3), elevated level of carcinoembryonic antigen (CEA, >5 ng/ml) at BM diagnosis, and extracranial metastases were adverse prognostic factors for OS. Patient with 0–1 factor showed better OS (at 1 year, 76.9%) than patients with 2 factors (16.7%) or 3–4 factors (4.2%; p < 0.001). In conclusion, we evaluated age, the number of BM, CEA level, and extracranial metastases as the prognostic factors for OS in CRC patients undergoing WBRT. Our result might be useful to develop prognostic models predicting survival for patients whom WBRT is intended for.

Highlights

Whole brain radiotherapy (WBRT) is a mainstay of the treatment for brain metastases (BM)
We excluded five patients who were lost to follow-up, one patient who underwent WBRT for pachymeningeal metastasis, and one patient with insufficient information of BM
Extracranial metastases were found in 86 patients (81.1%): the lungs (n = 68), lymph nodes (n = 47), liver (n = 44), bones (n = 31), and other locations (n = 26)

Summary

Introduction

Whole brain radiotherapy (WBRT) is a mainstay of the treatment for brain metastases (BM). We evaluated prognostic factors in colorectal cancer (CRC) patients undergoing WBRT for BM. Older age (>65 years), multiple BM (≥3), elevated level of carcinoembryonic antigen (CEA, >5 ng/ml) at BM diagnosis, and extracranial metastases were adverse prognostic factors for OS. We evaluated age, the number of BM, CEA level, and extracranial metastases as the prognostic factors for OS in CRC patients undergoing WBRT. Retrospective studies have reported young age, a single BM lesion, the absence of extracranial metastases, and a lower level of carcinoembryonic antigen (CEA) as good prognostic factors in CRC patients with BM4,7,8. CRC is not specified as a separate cancer subtype but is combined with other gastrointestinal (GI) cancers in the GPA indices In this context, we previously presented a Variables Median age (years) Sex Primary sites Primary laterality. The novel index included number of BM, CEA level, and the presence or absence of neurologic symptoms[11]

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