Brain metastases (BM) in colorectal cancer (CRC): Prognostic factors and survival analysis

Background

CRC BM are an uncommon event. Some clinical features have been associated with its occurrence but its knowledge remains limited.

Methods

We retrospectively analysed CRC patients who developed BM in our center between 1997-2016. Clinical factors (age, performance status [PS], CRC location, stage), RAS/BRAF status and survival were evaluated.

Results

28 patients developed BM and their median age was 64 years (21-81). 82% of the patients had left-sided CRC and 85% had PS0-1. Median time to BM diagnosis from CRC diagnosis was 36 months (m) (1.6-97). 92% of the patients received active treatment (46% whole-brain radiotherapy [WBRT], 46% surgery [S] with or without WBRT). RAS/BRAF were analysed in 60% of cases (47% RAS mutated, 0% BRAF mutated). Median survival (MS) from BM treatment was better for patients who underwent S with or without WBRT than for those treated with WBRT alone (11.3m versus [vs] 6.7m, p = 0.03). This result remained significant in multivariate analysis (MVA) (HR 0.36; 95% confidence interval [CI] 0.14-0.94, p = 0.038). CRC location showed impact on MS from BM treatment (4.6m vs 10.7m, p = 0.017, for right- and left-sided CRC); MVA remained significant (HR 3.19; 95%CI 1.12-13.6, p = 0.032). PS2 and right-sided CRC were associated with shorter time to BM diagnosis: 3.3m vs 43.8m for PS2 and PS0-1 (p 

Conclusions

Surgical treatment of CRC with or without WBRT seems superior to WBRT in terms of survival. Right-sided CRC and PS 2 were associated with worse outcome, while RAS status and other clinical factors had not shown prognostic value.

Clinical trial identification

Legal entity responsible for the study

Hospital de la Santa Creu i Sant Pau

Funding

Hospital de la Santa Creu i Sant Pau

Disclosure

All authors have declared no conflicts of interest.