Brain metastases from colorectal cancer: characteristics and management

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Excerpt

Brain metastases (BMs) are the most common intracranial neoplasms in adults. The vast majority of BMs arise from melanoma, lung and breast cancers. BMs from gastrointestinal cancer are uncommon.1 Among gastrointestinal cancers, colorectal cancer (CRC) has the highest incidence of BMs (2–3%). Incidence of CRC BMs may be increasing due to increased life expectancy of population and improved CRC prognosis, thanks to the progresses in chemotherapy and surgical treatment of advanced CRC.4 Furthermore, the widespread use of brain magnetic resonance imaging in the radiological workup of these patients, may account for an increased detection of BMs, although the routine use of brain imaging without clinical evidence of metastatic disease is neither beneficial nor cost‐effective regardless of the site of the primary tumour.5 However, a recent systematic review reported that the incidence of CRC BMs did not seem to increase over time.6
BMs usually occur in advanced stages of disease, with associated liver (50%) or lung (80%) metastases.7 Although the current therapeutic strategy for liver or lung metastases from CRC is well established,10 it is more variable for BMs. Indeed, current treatment options for CRC BMs include neurosurgery, whole‐brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and chemotherapy, alone or combined. Some clinical trials have suggested that the surgical resection followed by WBRT for the treatment of single BM resulted in longer survival and fewer recurrences.12 However, in the case of CRC BMs, the literature is scant, including only few retrospective series. These series showed that a better median overall survival could be obtained with surgical resection in case of solitary or oligometastatic brain disease compared with other modalities.8 Better control of CRC BMs in case of surgery combined with WBRT was also frequently reported, compared with surgery alone.7 Nevertheless, the prognosis of CRC BMs remains poor, and worse than other primary cancers such as melanoma, lung cancer and breast cancer.20 The management of patients with CRC BMs is therefore still an unresolved issue and an important healthcare challenge.
The objective of this systematic review was thus to report an overview of the characteristics and the current management of CRC BMs.

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