Tapia Rico Gonzalo, Price Timothy J, Karapetis Christos, Piantadosi Cynthia, Padbury Rob, Roy Amitesh, Maddern Guy, Moore James, Carruthers Scott, Roder David, Townsend Amanda R
Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Adelaide SA 5011, Australia.
Department of Medical Oncology, Flinders Medical Center and Flinders University, Adelaide SA 5042, Australia.
Cancer Biol Med. 2017 Nov;14(4):371-376. doi: 10.20892/j.issn.2095-3941.2017.0068.
Brain metastasis is considered rare in metastatic colorectal cancer (mCRC); thus, surveillance imaging does not routinely include the brain. The reported incidence of brain metastases ranges from 0.6% to 3.2%.
The South Australian mCRC Registry (SAmCRC) was analyzed to assess the number of patients presenting with brain metastasis during their lifetime. Due to small numbers, a descriptive analysis is presented.
Only 59 patients of 4,100 on the registry at the time of analysis had developed brain metastasis (1.4%). The clinical characteristics of those with brain metastasis were as follows: the median age was 65.3 years and 51% were female. Where the V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog () mutation status of the tumor was known, the majority harbored a mutation (55%); 31 (53%) underwent craniotomy and 55 (93%) underwent whole-brain radiotherapy. The median survival time from diagnosis of brain metastasis was 4.2 months (95% confidence interval 2.9-5.5). Patients who underwent craniotomy and radiotherapy had superior survival compared to those who underwent whole-brain radiotherapy (8.5 months . 2.2 months, respectively). Data from the SAmCRC (a population-based registry) confirm that brain metastases are rare and the median time to development is approximately 2 years.
Brain metastasis is a rare outcome in advanced CRC. Patients within the registry tended to be female, young in age, and harbored with higher rates of mutations. Whether routine surveillance brain scanning should be considered remains controversial given the relative rarity of developing brain metastases in mCRC and ultimately, most patients with central nervous system involvement die from their extracranial disease.
脑转移在转移性结直肠癌（mCRC）中被认为较为罕见；因此，监测成像通常不包括脑部。报道的脑转移发生率在0.6%至3.2%之间。
对南澳大利亚mCRC登记处（SAmCRC）进行分析，以评估一生中出现脑转移的患者数量。由于数量较少，进行了描述性分析。
分析时登记的4100例患者中，只有59例发生了脑转移（1.4%）。发生脑转移患者的临床特征如下：中位年龄为65.3岁，51%为女性。在已知肿瘤的V-Ki-ras2 Kirsten大鼠肉瘤病毒癌基因同源物（）突变状态的情况下，大多数患者携带 突变（55%）；31例（53%）接受了开颅手术，55例（93%）接受了全脑放疗。从脑转移诊断开始的中位生存时间为4.2个月（95%置信区间2.9 - 5.5）。与仅接受全脑放疗的患者相比，接受开颅手术和放疗的患者生存期更长（分别为8.5个月和2.2个月）。来自SAmCRC（一个基于人群的登记处）的数据证实，脑转移很少见，发生的中位时间约为2年。
脑转移是晚期结直肠癌中罕见的结局。登记处的患者倾向于女性、年龄较轻，且携带 突变的比例较高。鉴于mCRC发生脑转移相对罕见，以及最终大多数中枢神经系统受累的患者死于颅外疾病，是否应考虑进行常规监测脑部扫描仍存在争议。
