Brain metastasis from colorectal carcinoma. Clinical picture, treatment and prognosis

Abstract

Author(s): Tomasz Walasek

The occurrence of brain metastasis from colorectal carcinoma (BM-CRC) ranges from 0.06–4%. Their rare occurrence makes various issues associated with these lesions controversial. Based on the literature data, this article presents population characteristics and clinical features of BM-CRC, their treatment methods and prognostic factors in these patients. It has been demonstrated that BM-CRC is mainly detected in patients with advanced CRC (III° and IV°) and is usually preceded by lung and liver metastases. The authors report population- based characteristics of BM-CRC, i.e. greater frequency in males and mean patient age of 51–73 years, and clinical features, such as supratentorial location in over a half of cases, the occurrence of a single BM-CRC in a half of patients and median size of 24–33 mm. Moreover, the authors discuss treatment methods in BM-CRC, including surgery (stereotactic radiosurgery, SRS), whole brain radiotherapy (WBRT) and systemic treatment, applied either alone or in combination. The observation made in literature reports that aggressive surgery or SRS prolong survival and improve quality of life, particularly when combined with WBRT, has been confirmed. WBRT alone remains the mainstay of palliative BM-CRC treatment. It is also used in patients ineligible for surgery or SRS, with multiple BM-CRC, with poor performance status and with uncontrolled extracranial disease. Patients with BM-CRC present poor prognosis. Median overall survival (OS), as presented in the references from 2014–2016, ranges from 2 to 7 months. Higher OS rates are reported in selected groups of patients, mainly those primarily treated with surgery or SRS (5–14 months). The main positive prognostic factors in patients with BM-CRC are: the Karnofsky Performance Score (KPS) ≥70, BM-CRC number not greater than 2 and no active extracranial CRC.

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