Multimodality management of brain metastasis from colorectal cancer.

Authors

null

Zhaohui Jin

Mayo Clinic, Rochester, MN

Zhaohui Jin , William Breen , Rui Jin , Paul D. Brown , Joleen Marie Hubbard

Organizations

Mayo Clinic, Rochester, MN, Mayo clinic, Rochester, MN

Research Funding

No funding received
None

Background: More than 50% of colorectal cancer (CRC) patients will develop metastatic disease. Brain metastasis (BM) from colorectal cancer is uncommon (0.6-1.36%). This study aims to investigate the patient characteristics, treatment modalities and prognostic factors in this rare population. Methods: 104 patients with brain metastasis disease from CRC were identified from over 30,000 colorectal cancer patients at the Mayo Clinic Rochester between 1/1994 and 6/2019. A retrospective review was conducted by using data from electronic medical records (EMR). Statistical analysis utilized the Kaplan-Meier method, Log-rank test, and Cox proportional hazards models. Results: Among the 104 patients, 62 were male (59.6%) and 42 were female (40.4%). Median age at CRC diagnosis was 58.4 and at BM diagnosis was 61. Thirty-three patients had right-sided colon cancers, 27 patients had left-sided colon cancers and 39 patients had rectal cancer. Median time from CRC diagnosis to BM was 30.7 months. The majority of patients (58.7%) presented with a solitary brain lesion. Eighty-six patients (82.7%) had extracranial metastatic disease at BM diagnosis. Median survival was 7.0 months (95% CI 2.6-16.9) from BM diagnosis. Age <70, solitary BM, surgery, radiation, and chemotherapy were associated with statistically significant improved survival on univariate and multivariate analysis. Multi-modality treatment including surgical brain lesion resection, postoperative stereotactic radiation (SRS) with/without whole brain radiation (WBRT), and chemotherapy significantly improved median overall survival (Table). Conclusions: Although BM from CRC carries poor prognosis, multi-modality treatment (surgery, radiation and systemic chemotherapy) for patients with limited BM improves clinical outcome.

Median survival for mCRC patient with BM from time of BM diagnosis based on the treatment modality.

Treatment (patient number) Median Overall Survival (months) 95% Confidence Interval (months)
Best supportive care (7) 0.43 0-3.3
Radiation treatment (38) 3.13 2.53-5.26
Radiation/chemo (7) 12.2 2.47-21.94
Surgery (12) 4.8 1.78-9.70
Surgery/radiation (25) 14.0 7.40-16.91
Surgery/radiation/chemo (12) 41.1 19.41-53.19

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Abstract Details

Meeting

2020 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Anal and Colorectal Cancer

Track

Colorectal Cancer,Anal Cancer

Sub Track

Tumor Biology, Biomarkers, and Pathology

Citation

J Clin Oncol 38, 2020 (suppl 4; abstr 204)

Abstract #

204

Poster Bd #

K4

Abstract Disclosures