Brain Metastases Developed in Advanced Colorectal Cancer Patients who Underwent Multi-drug Chemotherapy

Park, Yong Keun; Lee, Sang Lim; Suh, Kwang Wook

Abstract

PURPOSE: Brain metastasis from colorectal cancer is a rare clinical condition. We have experienced five cases of brain metastases in a relatively short period of time during extensive chemotherapy for advanced colorectal cancer. To examine whether this phenomenon is a simple coincidence or there is a correlation with prolongation of life span in patients with stage IV colorectal cancer, we analysed five patients with brain metastases.
METHODS
The case histories of 47 patients with unresectable systemic metastases who had undergone sequential chemotherapy (FOLFOX and FOLFIRI) in Ajou University Hospital from August 2002 to December 2004 were reviewed and analyzed for clinical characteristics. The sites of unresectable metastases were the liver (n=28), the lung (n=28), and the paraaortic nodes (N=6). Diagnostic criteria of unresectable metastasis were multiple or bilobar lesions in hepatic metastasis and multilobar involvement in pulmonary metastasis.
RESULTS
There was no complete remission. Partial remission was noted in 31.9% of the patients and stable disease in 8.5%. Sequential chemotherapy showed no effect in 59.6% of the patients. Brain metastases occurred in five patients (10.6%). Accompanying metastases were found in the lung (n=4), the liver (n=3), the paralortic lymph nodes (n=2), and bone (n=1). Four patient (21.0%) were noted in the response group. The mean interval from primary cancer surgery to the diagnosis of brain metastasis was 27.5 (20~44) months. From the start of chemotherapy, brain metastasis was diagnosed at an average of 10.5 (8~16) months. Metastasectomies were performed in three patients, and stereotaxic radiosurgery was performed in two patients. One patient died with the disease, and four patients have been alive with the disease for more than six months.
CONCLUSIONS
It is still unclear whether the increasing incidence of brain metastasis is related with prolongation of life expectancy in patients with stage IV colorectal cancer. However, about half of the stage IV colorectal cancer patients were found to obtain meaningful survival benefits by sequential chemotherapy, and 20% of chemo- responders showed brain metastases. Therefore, we conclude that the increasing incidence of brain metastasis seems to correlate with prolongation of life expectancy in stage IV colorectal cancer.