Brain metastases in colorectal cancer patients: less rare than before
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LETTER TO THE EDITOR
Brain metastases in colorectal cancer patients: less rare than before Daniele Bernardi • Ottaviano Tomassi • Micaela Stefani • Alessia Di Giacobbe • Sebastiano D’Anna
Received: 25 January 2013 / Accepted: 16 February 2013 / Published online: 28 February 2013 Ó Springer-Verlag Italia 2013
Keywords Colorectal cancer Brain metastases Treatment Survival
Colorectal cancer (CRC) is the third leading cause of cancer death in the Western Countries. Even after complete resection of the colorectal tumor, distant metastases develop in 10–15 % of patients. Of all metastases, those to liver and lung are the most frequent, accounting for 20–30 % and 10–20 % of cases, respectively. Brain metastases in CRC patients are reported to be quite rare and the percentage of CRC patients developing brain metastases during the course of their disease ranges from 2 to 12 %. Nevertheless, the effect of brain metastases on the prognosis of CRC patients is significant. In fact, patients with brain metastases from CRC have a shorter survival than do those with brain metastases originating from other primary tumors [1]. The percentage of patients with longlasting metastatic colorectal disease bearing brain metastases has dramatically increased in the recent years [2]. In our opinion, this is certainly due to the benefit received in terms of survival by patients that had a chance to experience modern monoclonal-antibodies-based chemotherapy (bevacizumab, cetuximab, panitumumab). Longer survival with active metastatic disease means the possibility for metastatic cells hiding in the brain-sanctuary to grow and
D. Bernardi (&) O. Tomassi M. Stefani A. Di Giacobbe Division of Oncology, ULSS 10 ‘‘Veneto Orientale’’, Via N. Sauro 25, 30027 San Dona` di Piave (Venezia), Italy e-mail: [email protected] S. D’Anna Division of Neurology, ULSS 10 ‘‘Veneto Orientale’’, San Dona` di Piave (Venezia), Italy
become clinically evident. That is similar to what has been previously described with HER-2-overexpressing metastatic breast cancer patients receiving Trastuzumab and chemotherapy as treatment [3, 4], where taking into consideration the presence of brain metastases in neurologically symptomatic patients, even with extracerebral disease under control, is now standard procedure. Within the last month, at our institution, we have lost three of our longest-surviving metastatic colorectal cancer patients (8, 7 and 6 years, respectively) due to the sudden onset of brain metastases that became clinically evident and led patients to rapid death (4, 2 and 1 months). Radiation therapy was administered only to two patients and no treatment was applied in one patient due to rapidly deteriorating clinical conditions. Since there is solid evidence that an improvement in survival in this setting can be obtained with surgery followed by radiation therapy [5], we are now considering to include brain imaging in the restaging of all our long-surviving metastatic colorectal cancer patients. With this modification of our standar
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