Skip to main content
Top
Published in: International Journal of Colorectal Disease 2/2014

01-02-2014 | Original Article

Brain metastases from colorectal cancer: main clinical factors conditioning outcome

Authors: Elena Magni, Luigi Santoro, Paola S. Ravenda, Maria C. Leonardi, Guido Bonomo, Lorenzo Monfardini, Franco Nolè, Maria G. Zampino

Published in: International Journal of Colorectal Disease | Issue 2/2014

Login to get access

Abstract

Background

The aim of our study is to evaluate the outcome of patients affected by brain metastases from colorectal cancer and to correlate the outcome with prognostic factors.

Methods

Patients were retrospectively evaluated. Survival distributions were estimated by using the Kaplan–Meier method. The log-rank test was used to assess the impact on survival of individual factors.

Results

Among 41 patients (25M and 16F; median age 58), 58.5 % had rectal cancer and 39 % synchronous metastatic disease; 95 % had extracranial metastases, most common site was lung (87.8 %). Seven patients had synchronous brain metastases. Median overall survival after diagnosis of brain metastases was 5 months [95 % confidence interval 3–12 months]. Median survival from brain metastases diagnosis was 4.2 months in patients treated with radiotherapy (29.3 %), 11.9 months in those with radio- and chemotherapy (21.9 %) and 21.4 months in those with surgery with/without radiotherapy or chemotherapy (29.3 %) (P < 0.0001). On multivariate analysis, no independent prognostic factors were found for disease-free interval from diagnosis to brain metastases and overall survival; amount of chemotherapy before brain metastases have no statistically significant relation to brain-metastases-free-interval even if patients who received more than one line of chemotherapy have a longer median brain-metastases-free-interval than those who received less than one. KRAS was found mutated in 17/28 patients without statistically significant correlation to outcome due to the small sample size.

Conclusions

Prognosis of brain-metastases-patients is poor. An interesting tool is to evaluate the correlation of KRAS status and brain metastases with aim to tailor treatment and follow-up.
Literature
1.
go back to reference Hammoud MA, McCutcheon IE, Elsouki R, Schoppa D, Patt YZ (1996) Colorectal carcinoma and brain metastasis: distribution, treatment and survival. Ann Surg Oncol 5:453–463CrossRef Hammoud MA, McCutcheon IE, Elsouki R, Schoppa D, Patt YZ (1996) Colorectal carcinoma and brain metastasis: distribution, treatment and survival. Ann Surg Oncol 5:453–463CrossRef
2.
go back to reference Alden TD, Gianino JW, Saclarides TJ (1996) Brain metastases from colorectal cancer. Dis Colon Rectum 39(5):541–545PubMedCrossRef Alden TD, Gianino JW, Saclarides TJ (1996) Brain metastases from colorectal cancer. Dis Colon Rectum 39(5):541–545PubMedCrossRef
3.
go back to reference Wronski M, Arbit E (1999) Resection of brain metastases from colorectal carcinoma in 73 patients. Cancer 85(8):1677–1685PubMedCrossRef Wronski M, Arbit E (1999) Resection of brain metastases from colorectal carcinoma in 73 patients. Cancer 85(8):1677–1685PubMedCrossRef
4.
go back to reference Nieder C, Pawinski A, Balteskard L (2009) Colorectal cancer metastatic to the brain: time trends in presentation and outcome. Oncology 76:369–374PubMedCrossRef Nieder C, Pawinski A, Balteskard L (2009) Colorectal cancer metastatic to the brain: time trends in presentation and outcome. Oncology 76:369–374PubMedCrossRef
5.
go back to reference Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Rad Oncol Biol Phys 37:745–751CrossRef Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Rad Oncol Biol Phys 37:745–751CrossRef
6.
go back to reference Jung M, Ahn JB, Chang JH et al (2011) Brain metastases from colorectal carcinoma: prognostic factors and outcome. J Neurooncol 101:49–55PubMedCrossRef Jung M, Ahn JB, Chang JH et al (2011) Brain metastases from colorectal carcinoma: prognostic factors and outcome. J Neurooncol 101:49–55PubMedCrossRef
7.
go back to reference Krueser TJ, Chao ST, Elson P et al (2008) Multidisciplinary management of colorectal brain metastases: a retrospective study. Cancer 113(1):158–165CrossRef Krueser TJ, Chao ST, Elson P et al (2008) Multidisciplinary management of colorectal brain metastases: a retrospective study. Cancer 113(1):158–165CrossRef
8.
go back to reference Morovic JA, Chang SD (2011) Literature review of various treatment plans and outcomes for Brain Metastases from colorectal cancer. World Neurosurg 79(3–4):435–436 Morovic JA, Chang SD (2011) Literature review of various treatment plans and outcomes for Brain Metastases from colorectal cancer. World Neurosurg 79(3–4):435–436
9.
go back to reference Farnell GF, Buckner JC, Cascino TL, O’Connell MJ, Schomberg PJ, Suman V (1996) Brain metastases from colorectal carcinoma. The long term survivors. Cancer 78:711–716PubMedCrossRef Farnell GF, Buckner JC, Cascino TL, O’Connell MJ, Schomberg PJ, Suman V (1996) Brain metastases from colorectal carcinoma. The long term survivors. Cancer 78:711–716PubMedCrossRef
10.
go back to reference Baek JY, Kang MH, Hong YS et al (2011) Characteristics and prognosis of patients with colorectal cancer-associated brain metastases in the era of modern systemic chemotherapy. J Neurooncol 104(3):745–753PubMedCrossRef Baek JY, Kang MH, Hong YS et al (2011) Characteristics and prognosis of patients with colorectal cancer-associated brain metastases in the era of modern systemic chemotherapy. J Neurooncol 104(3):745–753PubMedCrossRef
11.
go back to reference Tajima Y, Ishibashi K, Ishiguro T et al (2009) Analysis of 12 cases of brain metastasis from colorectal cancer. Gan No Rinsho 36(12):2245–2247 Tajima Y, Ishibashi K, Ishiguro T et al (2009) Analysis of 12 cases of brain metastasis from colorectal cancer. Gan No Rinsho 36(12):2245–2247
12.
go back to reference Mongan JP, Fadul CE, Cole BF et al (2009) Brain metastases from colorectal cancer: risk factors, incidence, and the possible roles of chemokines. Clin Colorectal Cancer 8(2):100–105CrossRef Mongan JP, Fadul CE, Cole BF et al (2009) Brain metastases from colorectal cancer: risk factors, incidence, and the possible roles of chemokines. Clin Colorectal Cancer 8(2):100–105CrossRef
13.
go back to reference Tie J, Lipton L, Desai J et al (2011) KRAS mutation is associated with lung metastasis in patients with curatively resected colorectal cancer. Clin Cancer Res 17:1122–1130PubMedCrossRef Tie J, Lipton L, Desai J et al (2011) KRAS mutation is associated with lung metastasis in patients with curatively resected colorectal cancer. Clin Cancer Res 17:1122–1130PubMedCrossRef
Metadata
Title
Brain metastases from colorectal cancer: main clinical factors conditioning outcome
Authors
Elena Magni
Luigi Santoro
Paola S. Ravenda
Maria C. Leonardi
Guido Bonomo
Lorenzo Monfardini
Franco Nolè
Maria G. Zampino
Publication date
01-02-2014
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 2/2014
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-013-1781-y

Other articles of this Issue 2/2014

International Journal of Colorectal Disease 2/2014 Go to the issue