Outcomes Remain Poor for Colorectal Cancer Patients with Brain Metastases

Brain metastases from colorectal cancer are relatively rare, but their numbers seem to be on the rise. More evidence is needed to help clinicians better understand them and to guide treatment for those patients, especially since the average survival rate for patients with metastatic colon cancer is only approximately 30 months and brain metastases can impair function and substantially decrease a patient’s quality of life in the meantime.

A team of researchers in Brazil set out to uncover more details about brain metastases from colorectal cancer and published their findings in the journal Clinical Colorectal Cancer.

The researchers analyzed electronic medical records from 247 patients with brain metastases from colorectal cancer as part of a retrospective cohort study at a tertiary cancer center in São Paulo, Brazil. All of the patients had received treatment between May 2008 and April 2019. Of the 247 patients, 43 (17.4%) underwent surgery alone, 76 (30.8%) patients underwent radiation therapy alone, and 58 (23.5%) received a combination of the 2 types of treatment.

They found that brain metastases were more prevalent in the patients with primary tumors on the left side of their brains and a high volume of metastatic disease. They also found that patients who received both surgery and radiotherapy were the most likely to experience an improvement in their survival rate.

However, they wrote, “Notwithstanding all the advances in systemic treatment for colorectal cancer and radiotherapy techniques, our results show that these patients’ outcomes remain poor.”

Despite the prospect of a poor prognosis, they added, “some patients may benefit from aggressive local treatment strategies. Surgery and radiotherapy were associated with an improvement in the present study. Patients treated with both surgery and radiotherapy had the best outcomes.”

A limitation of this study was the lack of genomic analysis. The researchers only had access to information about a few possible mutations (notably KRAS and MMR) in some patients. Access to more detailed information about molecular features related to an increased risk of brain metastasis could be very helpful in future studies and might even help allow earlier identification of patients and guide the development of better treatment strategies for them.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Bonadio RC, Freitas GF, Batista DN, et al. Epidemiology and outcomes of patients with brain metastases from colorectal cancer — who are these patients? Clin Colorectal Cancer. Published online April 9, 2021. doi:10.1016/j.clcc.2021.04.002