|
|
Evidence for an
aggressive biological behaviour of brain metastases in advanced colorectal
cancer patients
C. Garufi, B. Vanni, C. Francesca, C. Campanella, A. M. Aschelter, E. Bria,
C. Nistic̣, F. Cuppone, I. Sperduti, E. Terzoli
Regina Elena Cancer Institute, Rome, Italy
Background.
Brain metastases (BM) occur in 4% of metastatic colorectal
cancer (CRC) patients and are considered as a late event in the natural course
of this disease with a median survival of only 3,8 months (Zorrilla M, Tumori
2001).
Methods.
We reviewed 240 patients with CRC from January 1995 to December
2002 and examined 16 of them (6,6%) with BM.
Results.
Patient characteristics: median age 62.5 years (range
21-78);
male/female 5/11;
PS at diagnosis 0-1: 13 pts (81%), PS 2: 3 pts (19%); PS at BM diagnosis 0-1: 12
pts (75%), 2: 4 pts (25%);
primary site colon/rectum 9/7;
synchronous/metachronous metastases 9 pts (57%)/ 7 pts (43%);
liver metastases 12 pts (75%), lung 10 pts (62%); other sites 5 pts (31%);
n° of previous chemotherapy lines 1 (6 pts), 2 (2 pts), 3 (4 pts), 4 (2 pts), 5
(1 pt).
Only three patients (18%) developed BM sinchronous with visceral metastases
(liver, lung, bones).
BM were diagnosed by TC in 6 pts (37%), MRI 8 pts (50%) or both 1 pt (6%), after
presence of the following neurological symptoms: headache 7 pts (44%),
hemiparesis 3 pts (19%), ataxia 6 pts (37%), diplopia 2 pts (12%) and other
symptoms 5 pts (31%).
The number of BM were 1-4 and > 4 in 14 pts (87%) and 2 pts (12%)
respectively; sites of BM: cerebral/cerebellar lesions 10 pts (62%)/ 6 pts
(37%).
Surgery for BM was performed in 2 pts (12%) with major- (1pt) and micro-surgery
resection (1pt);
RT was used in 10 pts (62%): whole brain RT 8 pts (50%) with a median dose of
34,5 Gy; stereotaxic RT 2 pts (12.5%), with a median dose of 15 Gy.
Nine patients (56%) underwent chemotherapy after surgical or radioterapic BM
treatment.
Median time from disease recurrence to BM diagnosis was 10 months (range 0-46);
median survival from BM diagnosis was 3 months (range 0-7) with 1 year OS of
8.6%.
Conclusions. BM in advanced CRC is still a rare event.
However our experience shows that BM occur within 12 months of metastatic
setting, indicating a peculiar biological aggressive behaviour in these
patients.
If confirmed early diagnosis and adequate treatment could improve poor patient
prognosis.
Copyright 2004 American Society of Clinical Oncology All rights
reserved worldwide.
Source: http://www.asco.org/ac/1,1003,_12-002636-00_18-0026-00_19-002586,00.asp
|
