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Colorectal carcinoma and brain metastasis: Distribution, treatment, and survival

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Abstract

Background: Brain metastasis from colorectal cancer is rare. The present study reports the nature of this disease and analyzes factors correlated with survival in patients harboring such disease.

Patients and Methods: One hundred patients diagnosed between 1980 and 1994 with metastatic brain tumors secondary to colorectal adenocarcinoma were retrospectively reviewed. Of these patients, 36 underwent surgery, 57 underwent radiotherapy alone, and the remaining seven received steroids.

Results: The most common primary sites were the sigmoid colon and rectum (65%). Brain metastases with concomitant liver and/or lung metastases were seen more frequently than brain metastases alone. The median interval between the diagnosis of primary cancer and the diagnosis of brain metastasis was 26 months (95% confidence interval =22–30). The median survival time after the diagnosis of brain metastasis was 1 month for patients who received only steroids, 3 months for those who received radiotherapy (p=0.1), and 9 months for those who underwent surgery (p<0.0001). The extent of noncerebral systemic disease was not correlated with survival (p>0.05), but early onset of brain metastasis was significantly associated with poor prognosis (p=0.04).

Conclusion: Surgical removal of colorectal metastatic brain lesions results in significantly increased survival time, regardless of the status of the noncerebral systemic disease.

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References

  1. Aronson SM, Garcia JH, Aronson BE. Metastatic neoplasms of the brain: their frequency in relation to age.Cancer 1964;17:558–63.

    CAS  PubMed  Google Scholar 

  2. Takakura K, Sano K, Hojo S, Hirano A.Metastatic tumors of the central nervous system. Tokyo: Igaku-Shoin, 1982.

    Google Scholar 

  3. Wright DC, Delaney TF, Buckner JC. Treatment of metastatic cancer to the brain. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.Principles and practice of oncology. 4th ed. Philadelphia: JB Lippincott, 1993:2170–86.

    Google Scholar 

  4. Winston KR, Walsh JW, Fischer EG. Results of operative treatment of intracranial metastatic tumors.Cancer 1980;45:2639–45.

    CAS  PubMed  Google Scholar 

  5. Cairncross JG, Kim J-H, Posner JB. Radiation therapy for brain metastases.Ann Neurol 1980;7:529–41.

    CAS  PubMed  Google Scholar 

  6. Weiss L, Grundmann E, Torhorst J, et al. Hematogenous metastatic patterns in colonic carcinoma: an analysis of 1541 necropsies.J Pathol 1986;150:195–203.

    Article  CAS  PubMed  Google Scholar 

  7. Floyd CE, Stirling CT, Cohn I Jr. Cancer of the colon, rectum and anus: review of 1,687 cases.Ann Surg 1966;163:829–37.

    CAS  PubMed  Google Scholar 

  8. Posner JB. Brain metastases: a clinician's view. In: Weiss L, Gilbert HA, Posner JB, eds.Brain metastases. Boston: GK Hall, 1980:2–29.

    Google Scholar 

  9. Moertel CG. Accomplishments in surgical adjuvant therapy for large bowel cancer.Cancer 1992;70:1364–71.

    CAS  PubMed  Google Scholar 

  10. Galicich JH, Sundaresan N, Arbit E, Passe S. Surgical treatment of single brain metastasis: factors associated with survival.Cancer 1980;45:381–6.

    CAS  PubMed  Google Scholar 

  11. Sundaresan N, Galicich JH. Surgical treatment of brain metastases. Clinical and computerized tomography evaluation of the results of treatment.Cancer 1985;55:1382–8.

    CAS  PubMed  Google Scholar 

  12. Sato H, Tsuchiya A, Nomizu T, et al. The neurosurgical management of brain metastasis from colorectal cancer.Surg Today 1993;23:639–43.

    CAS  PubMed  Google Scholar 

  13. Cascino TL, Leavengood JM, Kemeny N, Posner JB. Brain metastasis from colon cancer.J Neurooncol 1983;1:203–9.

    CAS  PubMed  Google Scholar 

  14. Chyun Y, Hayward E, Lokich J. Metastasis to the central nervous system from colorectal cancer.Med Pediatr Oncol 1980;8:305–8.

    CAS  PubMed  Google Scholar 

  15. Rovirosa R, Bodi R, Vincente P, Lastuey I, Giralt J, Salvador L. Metastasis cerebrales en el adenocarcinoma de colon.Rev Esp Enferm Dig 1991;79:281–3.

    CAS  PubMed  Google Scholar 

  16. Sriram I, Banmann MA. Multiple isolated brain metastases from a Dukes' B colon carcinoma.Irish J Med Sci 1991;160:275–6.

    CAS  PubMed  Google Scholar 

  17. Ruelle A. Brain metastasis from colon cancer. Case report showing a clinical and CT unusual appearance.J Neurosurg Sci 1987;31:33–6.

    CAS  PubMed  Google Scholar 

  18. Karnofsky DA, Barachend LJH, Armstead GD, et al. Triethyline melanine in the treatment of neoplastic disease.Arch Intern Med 1951;87:477–516.

    CAS  Google Scholar 

  19. Cox DR. Regression models and life tables.J R Stat Soc 1972;B34:187–220.

    Google Scholar 

  20. Kaplan EL, Meier P. Non-parametric estimation from incomplete observation.J Am Stat Assoc 1958;53:457–81.

    Google Scholar 

  21. Wingo PA, Tong T, Bolden S. Cancer statistics, 1995.CA 1995;45:8–20.

    CAS  PubMed  Google Scholar 

  22. Olson RM, Perencevich NP, Malcolm AW, Chattey JT, Wilson RE. Patterns of recurrence following curative resection of adenocarcinoma of the colon and rectum.Cancer 1980;45:2969–74.

    CAS  PubMed  Google Scholar 

  23. Dawson LE, Russell AH, Tong D, Wisbeck WM. Adenocarcinoma of the sigmoid colon: sites of initial dissemination and clinical patterns of recurrence following surgery alone.J Surg Oncol 1983;22:95–9.

    CAS  PubMed  Google Scholar 

  24. Minsky BD, Mies C, Rich TA, Recht A, Chaffey JT. Potentially curative surgery of colon cancer: patterns of failure and survival.J Clin Oncol 1988;6:106–18.

    CAS  PubMed  Google Scholar 

  25. Pilipshen SJ, Heilweil M, Quan SHQ, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer.Cancer 1984;53:1354–62.

    CAS  PubMed  Google Scholar 

  26. Foster JH. Survival after liver resection for secondary tumors.Am J Surg 1978;135:389–94.

    Article  CAS  PubMed  Google Scholar 

  27. Patanaphan V, Salazar OM. Colorectal cancer: metastatic patterns and prognosis.South Med J 1993;86:38–41.

    CAS  PubMed  Google Scholar 

  28. Williams PL, Warwick R.Gray's anatomy. 36th ed. Edinburgh, Scotland: Churchill Livingstone, 1980.

    Google Scholar 

  29. Amer MH, Al-Sarraf M, Baker LH, Vaitkevicius VK. Malignant melanoma and central nervous system metastases. Incidence, diagnosis, treatment and survival.Cancer 1978;42:660–8.

    CAS  PubMed  Google Scholar 

  30. Chason JL, Walker FB, Landers JW. Metastatic carcinoma in the central nervous system and dorsal root ganglia. A prospective autopsy study.Cancer 1963;16:781–7.

    CAS  PubMed  Google Scholar 

  31. Delattre JY, Krol G, Thaler HT, Posner JB. Distribution of brain metastases.Arch Neurol 1988;45:741–4.

    CAS  PubMed  Google Scholar 

  32. Davis PC, Hudgins PA, Peterman SB, Hoffman JC Jr. Diagnosis of cerebral metastases: double-dose delayed CT vs contrast-enhanced MR imaging.Am J Neuroradiol 1991;12:293–300.

    CAS  PubMed  Google Scholar 

  33. Sze G, Milano E, Johnson C, Heier L. Detection of brain metastases: comparison of contrast-enhanced MR with unenhanced MR and enhanced CT.Am J Neuroradiol 1990;11:785–91.

    CAS  PubMed  Google Scholar 

  34. Ask-Upmark E. Metastatic tumors of the brain and their localization.Acta Med Scand 1956;154:1–9.

    CAS  PubMed  Google Scholar 

  35. Graf AH, Buckberger W, Langmayr H, Schmid KW. Site preference of metastatic tumours of the brain.Virchows Arch [A] 1988;412:493–8.

    CAS  Google Scholar 

  36. Lang EF, Slater J. Metastatic brain tumors: results of surgical and nonsurgical treatment.Surg Clin North Am 1964;44:865–72.

    CAS  PubMed  Google Scholar 

  37. Vaneck JHM, Go KG, Ebels EJ. Metastatic tumors of the brain.Psychiatr Neurol Neurochir 1965;68:443–62.

    CAS  Google Scholar 

  38. Markesbery WR, Brooks WH, Gupta GD, Young AB. Treatment for patients with cerebral metastases.Arch Neurol 1978;35:754–6.

    CAS  PubMed  Google Scholar 

  39. Ruderman NB, Hall TC. Use of glucocorticoids in the palliative treatment of metastatic brain tumors.Cancer 1965;18:298–306.

    CAS  PubMed  Google Scholar 

  40. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain.N Engl J Med 1990;322:494–500.

    CAS  PubMed  Google Scholar 

  41. Kuratsu J, Matsukado Y, Nonaka N, et al. Computed tomography in brain metastasis of colorectal cancer [in Japanese].CT Kenkyuu 1984;6:543–7.

    Google Scholar 

  42. Yoshikawa N, Sasai T, Shimase K, et al. The study of brain metastasis from colorectal cancer [in Japanese].Geka Shinryou 1981;23:61–4.

    Google Scholar 

  43. Wakisaka S, Kureya A, Miyahara K, et al. Clinical study of metastatic brain tumors from carcinomas of the digestive organs [in Japanese].Gan No Rinsho 1989;35:1654–49.

    Google Scholar 

  44. Galicich JH, Arbit E. Metastatic brain tumors. In: Youman JR, ed.Neurological surgery. 3rd ed. Philadelphia: WB Saunders, 1990:3204–22.

    Google Scholar 

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Hammound, M.A., McCutcheon, I.E., Elsouki, R. et al. Colorectal carcinoma and brain metastasis: Distribution, treatment, and survival. Annals of Surgical Oncology 3, 453–463 (1996). https://doi.org/10.1007/BF02305763

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