Multidisciplinary management of colorectal brain metastases - A retrospective study
Multidisciplinary management of colorectal brain metastases - A retrospective study
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DOI：
10.1002/cncr.23531
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发表时间：
2008-07-01
期刊：
影响因子：
6.2
通讯作者：
Suh, John H.
中科院分区：
文献类型：
--
作者：
Kruser, Tim J.;Chao, Samuel T.;Suh, John H.
背景。结直肠癌 (CRC) 脑转移 (BM) 的发病率正在增加，并且有报道称在单一机构对这种以前罕见的并发症进行了治疗。方法。对 1994 年至 2005 年所有 BM 患者的记录进行了审查，并确定了 49 名患者（33 名男性，16 名女性）患有 CRC 的 102 例 BM。评估了患者与肿瘤特征、治疗方式和生存之间的关联。结果。诊断 CRC BM 时的中位年龄为 66 岁。四十名患者（82%）患有其他全身性疾病。诊断出 CRC BM 后的中位生存期为 5.1 个月。 15 名患者 (31%) 在某个时间接受了手术，14 名患者 (29%) 接受了立体定向放射外科 (SRS)，42 名患者 (86%) 在治疗期间接受了全脑放疗。 7 名患者 (14%) 接受了前期 SRS。多变量分析显示，从 CRC 诊断到 BM 诊断的时间间隔较长与较短的生存期显着相关 (p = 0.01)。性别、卡诺夫斯基表现状态、肿瘤位置、递归分区分析类别和初始治疗方式对生存没有影响。结论。由于结直肠癌的脑转移是一种晚期现象，因此本研究中的大多数患者有其他全身受累，中枢神经系统受累后的生存率很差。结果表明，全身性疾病的高患病率限制了适合预先接受 SRS 的患者比例，从而限制了这种方式对该人群整体结果的影响。中枢神经系统受累的晚期发展（原发肿瘤诊断后 >1 年）可能预示着 CRC BM 患者治疗后生存率较差。
BACKGROUND. The incidence of brain metastases (BM) from colorectal cancer (CRC) is increasing, and the management of this previously rare complication at a single institution is reported.METHODS. The records of all patients with BM from 1994 to 2005 were reviewed, and 49 patients (33 men, 16 women) with 102 BM from CRC were identified. Associations between patient and tumor characteristics, treatment modality, and survival were assessed.RESULTS. The median age at diagnosis of BM from CRC was 66 years. Forty patients (82%) had other systemic disease. The median survival after a diagnosis of BM from CRC was 5.1 months. Fifteen patients (31%) underwent surgery at some point, 14 patients (29%) underwent stereotactic radiosurgery (SRS), and 42 patients (86%) received whole-brain radiotherapy during their management. Seven patients (14%) underwent upfront SRS. On multivariate analysis, a longer interval from diagnosis of CRC to diagnosis of BM was associated significantly with shorter survival (p =.01). Sex, Karnofsky performance status, tumor location, recursive partitioning analysis class, and initial treatment modality did not have an impact on survival.CONCLUSIONS. Because BM from CRC are a late-stage phenomenon, the majority of patients in the current study had other systemic involvement, and survival after CNS involvement was poor. The results indicated that a high prevalence of systemic disease limits the proportion of patients who are strong candidates for upfront SRS, thereby limiting the impact that this modality has on outcomes in this population as a whole. Late development (>1 year after the primary tumor diagnosis) of CNS involvement may predict for poorer survival after therapy for patients with BM from CRC.