Progress in diagnosis and treatment of brain metastasis from colorectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Lingling ¹ , SUN Lichao ² ,  LIU Zheng ¹ ,  RAN Yuliang ²

1. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, P. R. China;
2. State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, P. R. China;

Corresponding author：

LIU Zheng, Email: zheng.liu@cicams.ac.cn; RAN Yuliang, Email: ran_yuliang@126.com

Keywords：

colorectal cancer; brain metastasis; clinicopathologic characteristics; diagnosis; treatment; prognosis

DOI：

10.7507/1007-9424.202103040

Video：

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Objective To elucidate the clinical and pathological features and review the progress of diagnosis and treatment in patients with brain metastasis (BM) from colorectal cancer (CRC), so as to provide a reference for the whole process management for patients with BM from CRC in China.Method The latest research results and previous literatures about patients with BM from CRC were reviewed.Results The prognosis of BM from CRC was poor, its molecular pathological mechanism was complex and diverse, and some risk factors associated with the occurrence of BM had been identified. Typical imaging features of BM from CRC were helpful to the diagnosis of patients. At present, radiotherapy was still the main treatment. Bevacizumab treatment or immunotherapy combined with radiotherapy was expected to improve the survival of BM from CRC.Conclusion Scientific and standardized prevention, diagnosis, and treatment are beneficial to reduce incidence of BM from CRC and improve survival.

Citation： WANG Lingling, SUN Lichao, LIU Zheng, RAN Yuliang. Progress in diagnosis and treatment of brain metastasis from colorectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(1): 102-106. doi: 10.7507/1007-9424.202103040 Copy

1.	Imaizumi J, Shida D, Narita Y, et al. Prognostic factors of brain metastases from colorectal cancer. BMC Cancer, 2019, 19(1): 755.
2.	Barnholtz-Sloan JS, Sloan AE, Davis FG, et al. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol, 2004, 22(14): 2865-2872.
3.	Schouten LJ, Rutten J, Huveneers HA, et al. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer, 2002, 94(10): 2698-2705.
4.	Christensen TD, Spindler KL, Palshof JA, et al. Systematic review: brain metastases from colorectal cancer—Incidence and patient characteristics. BMC Cancer, 2016, 16: 260.
5.	Jung M, Ahn JB, Chang JH, et al. Brain metastases from colorectal carcinoma: prognostic factors and outcome. J Neurooncol, 2011, 101(1): 49-55.
6.	Christensen TD, Palshof JA, Larsen FO, et al. Risk factors for brain metastases in patients with metastatic colorectal cancer. Acta Oncol, 2017, 56(5): 639-645.
7.	Roussille P, Tachon G, Villalva C, et al. Pathological and molecular characteristics of colorectal cancer with brain metastases. Cancers (Basel), 2018, 10(12): 504.
8.	Koo T, Kim K, Park HJ, et al. Prognostic factors for survival in colorectal cancer patients with brain metastases undergoing whole brain radiotherapy: multicenter retrospective study. Sci Rep, 2020, 10(1): 4340.
9.	Michl M, Thurmaier J, Schubert-Fritschle G, et al. Brain metastasis in colorectal cancer patients: survival and analysis of prognostic factors. Clin Colorectal Cancer, 2015, 14(4): 281-290.
10.	李宁, 杨渤彦, 边志民. 肠癌脑转移临床特征及预后因素分析. 中国肿瘤临床与康复, 2017, 24(9): 1036-1039.
11.	Nieder C, Hintz M, Popp I, et al. Validation of the graded prognostic assessment for gastrointestinal cancers with brain metastases (GI-GPA). Radiat Oncol, 2020, 15(1): 35.
12.	Pietrantonio F, Aprile G, Rimassa L, et al. A new nomogram for estimating survival in patients with brain metastases secondary to colorectal cancer. Radiother Oncol, 2015, 117(2): 315-321.
13.	Dong J, Wu L, Wang F, et al. The choice of local treatment modalities for patients with brain metastases from digestive cancers. J Oncol, 2019, 2019: 1568465.
14.	Tapia Rico G, Price TJ, Karapetis C, et al. Brain metastasis in advanced colorectal cancer: results from the South Australian metastatic colorectal cancer (SAmCRC) registry. Cancer Biol Med, 2017, 14(4): 371-376.
15.	Boysen AK, Ording AG, Astradsson A, et al. Metastasis directed treatment of brain metastases from colorectal cancer—a Danish population-based cohort study. Acta Oncol, 2020, 59(9): 1118-1122.
16.	Li Y, Li Q, Mo H, et al. Incidence, risk factors and survival of patients with brain metastases at initial metastatic breast cancer diagnosis in China. Breast, 2021, 55: 30-36.
17.	Tan RYC, Camat MD, Ng M, et al. HER2 positive rates are enriched amongst colorectal cancer brain metastases: a study amongst 1 920 consecutive patients. Ann Oncol, 2018, 29(7): 1598-1599.
18.	Gu XD, Cai YT, Zhou YM, et al. Prognostic factors and multidisciplinary treatment modalities for brain metastases from colorectal cancer: analysis of 93 patients. BMC Cancer, 2015, 15: 902.
19.	Sun J, Wang C, Zhang Y, et al. Genomic signatures reveal DNA damage response deficiency in colorectal cancer brain metastases. Nat Commun, 2019, 10(1): 3190.
20.	中国医师协会结直肠肿瘤专业委员会. 中国结直肠癌脑转移多学科综合治疗专家共识(2020 版). 中华结直肠疾病电子杂志, 2020, 9(2): 109-114.
21.	谷春雨, 王浩然, 张明山, 等. 结直肠癌脑转移的影像学特点. 中国微侵袭神经外科杂志, 2019, 24(11): 507-508.
22.	Dobra G, Bukva M, Szabo Z, et al. Small extracellular vesicles isolated from serum may serve as signal-enhancers for the monitoring of CNS tumors. Int J Mol Sci, 2020, 21(15): 5359.
23.	薛源, 李沛东, 张广军. 结直肠癌患者血清外泌体 microRNAs 的研究进展. 中国普外基础与临床杂志, 2020, 27(9): 1169-1174.
24.	Nieder C, Hintz M, Grosu AL. Colorectal cancer metastatic to the brain: analysis of prognostic factors and impact of KRAS mutations on presentation and outcome. Clin Transl Oncol, 2016, 18(1): 88-92.
25.	Rades D, Hansen HC, Janssen S, et al. Diagnosis-specific WBRT-30-CRC score for estimating survival of patients irradiated for brain metastases from colorectal cancer. Anticancer Res, 2019, 39(5): 2569-2574.
26.	Lupattelli M, Alì E, Ingrosso G, et al. Stereotactic radiotherapy for brain metastases: imaging tools and dosimetric predictive factors for radionecrosis. J Pers Med, 2020, 10(3): 59.
27.	Brown PD, Jaeckle K, Ballman KV, et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA, 2016, 316(4): 401-409.
28.	National Comprehensive Cancer Network. Central nervous system cancers NCCN guidelines. (2021-04-15). https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf. [Accessed 1 March 2021].
29.	杨艳艳, 魏孝礼, 白玉贤. 结直肠癌脑转移的研究进展. 医学综述, 2018, 24(13): 2592-2596.
30.	Baek JY, Kang MH, Hong YS, et al. Characteristics and prognosis of patients with colorectal cancer-associated brain metastases in the era of modern systemic chemotherapy. J Neurooncol, 2011, 104(3): 745-753.
31.	Yoshida Y, Hoshino S, Aisu N, et al. Efficacy of XELOX plus bevacizumab in brain metastasis from rectal cancer. Case Rep Oncol, 2014, 7(1): 117-121.
32.	董奇观, 张玉扬, 杨玉超, 等. 替莫唑胺联合全脑放疗治疗结直肠癌脑转移的临床疗效分析. 中国现代医生, 2017, 55(26): 62-64.
33.	Davies H, Glodzik D, Morganella S, et al. HRDetect is a predictor of BRCA1 and BRCA2 deficiency based on mutational signatures. Nat Med, 2017, 23(4): 517-525.
34.	Zhuang H, Shi S, Yuan Z, et al. Bevacizumab treatment for radiation brain necrosis: mechanism, efficacy and issues. Mol Cancer, 2019, 18(1): 21.
35.	Finkelmeier F, You SJ, Waidmann O, et al. Bevacizumab in combination with chemotherapy for colorectal brain metastasis. J Gastrointest Cancer, 2016, 47(1): 82-88.
36.	Berghoff AS, Preusser M. Anti-angiogenic therapies in brain metastases. Memo, 2018, 11(1): 14-17.
37.	刘恩瑞, 王贵玉. 程序性死亡受体-1 及其配体抑制剂在结直肠癌中的研究进展. 中国普外基础与临床杂志, 2019, 26(5): 620-624.
38.	Amin S, Baine MJ, Meza JL, et al. Association of immunotherapy with survival among patients with brain metastases whose cancer was managed with definitive surgery of the primary tumor. JAMA Netw Open, 2020, 3(9): e2015444.
39.	Pin Y, Paix A, Todeschi J, et al. Brain metastasis formation and irradiation by stereotactic radiation therapy combined with immunotherapy: a systematic review. Crit Rev Oncol Hematol, 2020, 149: 102923.
40.	邓义飞, 苏州, 薛建新. 立体定向放射外科治疗联合免疫检测点抑制剂在脑转移瘤中的应用. 华西医学, 2021, 36(1): 125-130.
41.	Dutta R, Khalil R, Green R, et al. Withania somnifera (Ashwagandha) and withaferin A: potential in integrative oncology. Int J Mol Sci, 2019, 20(21): 5310.
42.	朱纪烨, 杨泽芳, 张红. 补阳还五汤加味联合贝伐单抗治疗肺癌脑转移临床观察. 实用中医内科杂志, 2021, 35(4): 117-120.
43.	Thurmaier J, Heinemann V, Engel J, et al. Patients with colorectal cancer and brain metastasis: the relevance of extracranial metastatic patterns predicting time intervals to first occurrence of intracranial metastasis and survival. Int J Cancer, 2021, 148(8): 1919-1927.

1. Imaizumi J, Shida D, Narita Y, et al. Prognostic factors of brain metastases from colorectal cancer. BMC Cancer, 2019, 19(1): 755.
2. Barnholtz-Sloan JS, Sloan AE, Davis FG, et al. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol, 2004, 22(14): 2865-2872.
3. Schouten LJ, Rutten J, Huveneers HA, et al. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer, 2002, 94(10): 2698-2705.
4. Christensen TD, Spindler KL, Palshof JA, et al. Systematic review: brain metastases from colorectal cancer—Incidence and patient characteristics. BMC Cancer, 2016, 16: 260.
5. Jung M, Ahn JB, Chang JH, et al. Brain metastases from colorectal carcinoma: prognostic factors and outcome. J Neurooncol, 2011, 101(1): 49-55.
6. Christensen TD, Palshof JA, Larsen FO, et al. Risk factors for brain metastases in patients with metastatic colorectal cancer. Acta Oncol, 2017, 56(5): 639-645.
7. Roussille P, Tachon G, Villalva C, et al. Pathological and molecular characteristics of colorectal cancer with brain metastases. Cancers (Basel), 2018, 10(12): 504.
8. Koo T, Kim K, Park HJ, et al. Prognostic factors for survival in colorectal cancer patients with brain metastases undergoing whole brain radiotherapy: multicenter retrospective study. Sci Rep, 2020, 10(1): 4340.
9. Michl M, Thurmaier J, Schubert-Fritschle G, et al. Brain metastasis in colorectal cancer patients: survival and analysis of prognostic factors. Clin Colorectal Cancer, 2015, 14(4): 281-290.
10. 李宁, 杨渤彦, 边志民. 肠癌脑转移临床特征及预后因素分析. 中国肿瘤临床与康复, 2017, 24(9): 1036-1039.
11. Nieder C, Hintz M, Popp I, et al. Validation of the graded prognostic assessment for gastrointestinal cancers with brain metastases (GI-GPA). Radiat Oncol, 2020, 15(1): 35.
12. Pietrantonio F, Aprile G, Rimassa L, et al. A new nomogram for estimating survival in patients with brain metastases secondary to colorectal cancer. Radiother Oncol, 2015, 117(2): 315-321.
13. Dong J, Wu L, Wang F, et al. The choice of local treatment modalities for patients with brain metastases from digestive cancers. J Oncol, 2019, 2019: 1568465.
14. Tapia Rico G, Price TJ, Karapetis C, et al. Brain metastasis in advanced colorectal cancer: results from the South Australian metastatic colorectal cancer (SAmCRC) registry. Cancer Biol Med, 2017, 14(4): 371-376.
15. Boysen AK, Ording AG, Astradsson A, et al. Metastasis directed treatment of brain metastases from colorectal cancer—a Danish population-based cohort study. Acta Oncol, 2020, 59(9): 1118-1122.
16. Li Y, Li Q, Mo H, et al. Incidence, risk factors and survival of patients with brain metastases at initial metastatic breast cancer diagnosis in China. Breast, 2021, 55: 30-36.
17. Tan RYC, Camat MD, Ng M, et al. HER2 positive rates are enriched amongst colorectal cancer brain metastases: a study amongst 1 920 consecutive patients. Ann Oncol, 2018, 29(7): 1598-1599.
18. Gu XD, Cai YT, Zhou YM, et al. Prognostic factors and multidisciplinary treatment modalities for brain metastases from colorectal cancer: analysis of 93 patients. BMC Cancer, 2015, 15: 902.
19. Sun J, Wang C, Zhang Y, et al. Genomic signatures reveal DNA damage response deficiency in colorectal cancer brain metastases. Nat Commun, 2019, 10(1): 3190.
20. 中国医师协会结直肠肿瘤专业委员会. 中国结直肠癌脑转移多学科综合治疗专家共识(2020 版). 中华结直肠疾病电子杂志, 2020, 9(2): 109-114.
21. 谷春雨, 王浩然, 张明山, 等. 结直肠癌脑转移的影像学特点. 中国微侵袭神经外科杂志, 2019, 24(11): 507-508.
22. Dobra G, Bukva M, Szabo Z, et al. Small extracellular vesicles isolated from serum may serve as signal-enhancers for the monitoring of CNS tumors. Int J Mol Sci, 2020, 21(15): 5359.
23. 薛源, 李沛东, 张广军. 结直肠癌患者血清外泌体 microRNAs 的研究进展. 中国普外基础与临床杂志, 2020, 27(9): 1169-1174.
24. Nieder C, Hintz M, Grosu AL. Colorectal cancer metastatic to the brain: analysis of prognostic factors and impact of KRAS mutations on presentation and outcome. Clin Transl Oncol, 2016, 18(1): 88-92.
25. Rades D, Hansen HC, Janssen S, et al. Diagnosis-specific WBRT-30-CRC score for estimating survival of patients irradiated for brain metastases from colorectal cancer. Anticancer Res, 2019, 39(5): 2569-2574.
26. Lupattelli M, Alì E, Ingrosso G, et al. Stereotactic radiotherapy for brain metastases: imaging tools and dosimetric predictive factors for radionecrosis. J Pers Med, 2020, 10(3): 59.
27. Brown PD, Jaeckle K, Ballman KV, et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA, 2016, 316(4): 401-409.
28. National Comprehensive Cancer Network. Central nervous system cancers NCCN guidelines. (2021-04-15). https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf. [Accessed 1 March 2021].
29. 杨艳艳, 魏孝礼, 白玉贤. 结直肠癌脑转移的研究进展. 医学综述, 2018, 24(13): 2592-2596.
30. Baek JY, Kang MH, Hong YS, et al. Characteristics and prognosis of patients with colorectal cancer-associated brain metastases in the era of modern systemic chemotherapy. J Neurooncol, 2011, 104(3): 745-753.
31. Yoshida Y, Hoshino S, Aisu N, et al. Efficacy of XELOX plus bevacizumab in brain metastasis from rectal cancer. Case Rep Oncol, 2014, 7(1): 117-121.
32. 董奇观, 张玉扬, 杨玉超, 等. 替莫唑胺联合全脑放疗治疗结直肠癌脑转移的临床疗效分析. 中国现代医生, 2017, 55(26): 62-64.
33. Davies H, Glodzik D, Morganella S, et al. HRDetect is a predictor of BRCA1 and BRCA2 deficiency based on mutational signatures. Nat Med, 2017, 23(4): 517-525.
34. Zhuang H, Shi S, Yuan Z, et al. Bevacizumab treatment for radiation brain necrosis: mechanism, efficacy and issues. Mol Cancer, 2019, 18(1): 21.
35. Finkelmeier F, You SJ, Waidmann O, et al. Bevacizumab in combination with chemotherapy for colorectal brain metastasis. J Gastrointest Cancer, 2016, 47(1): 82-88.
36. Berghoff AS, Preusser M. Anti-angiogenic therapies in brain metastases. Memo, 2018, 11(1): 14-17.
37. 刘恩瑞, 王贵玉. 程序性死亡受体-1 及其配体抑制剂在结直肠癌中的研究进展. 中国普外基础与临床杂志, 2019, 26(5): 620-624.
38. Amin S, Baine MJ, Meza JL, et al. Association of immunotherapy with survival among patients with brain metastases whose cancer was managed with definitive surgery of the primary tumor. JAMA Netw Open, 2020, 3(9): e2015444.
39. Pin Y, Paix A, Todeschi J, et al. Brain metastasis formation and irradiation by stereotactic radiation therapy combined with immunotherapy: a systematic review. Crit Rev Oncol Hematol, 2020, 149: 102923.
40. 邓义飞, 苏州, 薛建新. 立体定向放射外科治疗联合免疫检测点抑制剂在脑转移瘤中的应用. 华西医学, 2021, 36(1): 125-130.
41. Dutta R, Khalil R, Green R, et al. Withania somnifera (Ashwagandha) and withaferin A: potential in integrative oncology. Int J Mol Sci, 2019, 20(21): 5310.
42. 朱纪烨, 杨泽芳, 张红. 补阳还五汤加味联合贝伐单抗治疗肺癌脑转移临床观察. 实用中医内科杂志, 2021, 35(4): 117-120.
43. Thurmaier J, Heinemann V, Engel J, et al. Patients with colorectal cancer and brain metastasis: the relevance of extracranial metastatic patterns predicting time intervals to first occurrence of intracranial metastasis and survival. Int J Cancer, 2021, 148(8): 1919-1927.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress in diagnosis and treatment of brain metastasis from colorectal cancer

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