Brain Metastases from Colorectal Cancer: Risk Factors,Incidence, and the Possible Role of Chemokines |
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| Authors: | John P Mongan Camilo E Fadul Bernard F Cole Bassem I Zaki Arief A Suriawinata Gregory H Ripple Tor D Tosteson J Marc Pipas |
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| Affiliation: | 1. Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH;2. James P. Wilmot Cancer Center, University of Rochester, NY;3. Section of Hematology & Oncology, Norris Cotton Cancer Center/Dartmouth-Hitchcock Medical Center, Lebanon, NH;4. Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH;5. Section of Radiation Oncology, Norris Cotton Cancer Center/Dartmouth-Hitchcock Medical Center, Lebanon, NH;6. Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH;7. Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH;1. Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;2. Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea;3. Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea;4. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;5. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;6. Section of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;1. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands;2. Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands;3. Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands;4. Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands;5. Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands;6. NDDO Institute for Prevention and Early Diagnostics, Amsterdam, The Netherlands;1. Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France;2. Department of Medical Oncology, Gustave Roussy, Villejuif, France;3. Department of Medical and Translational Research, Centre René Gauducheau, Saint-Herblain, France;4. Department of Urologic and Digestive Oncology, Centre Oscar Lambret, Lille, France;5. Department of Visceral Surgery, Gustave Roussy, Villejuif, France;6. Department of Hepatogastroenterology and Digestive Oncology, Hôpital Robert Debré, Reims, France;1. Department of Dermatology, University Hospital Zurich, Zurich, Switzerland;2. Multidisciplinary Center Lausanne, Quartier UNIL-Sorge, Lausanne, Switzerland;3. F. Hoffmann-La Roche Ltd, Basel, Switzerland;4. MRI Bethanien, Zurich, Switzerland;1. Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA;2. Department of Medicine, Emory University, Atlanta, GA |
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| Abstract: | BackgroundBrain metastases from colorectal cancer (CRC) are uncommon. There has been relatively little published on the host and tumor factors that might lead to this clinical scenario. We reviewed all cases of brain metastases from CRC at Dartmouth-Hitchcock Medical Center over a more than 20-year period to establish incidence and to identify patient and cancer characteristics which were associated with their development.Patients and MethodsWe present a retrospective review of 39 confirmed cases of brain metastases from CRC diagnosed between 1984 and 2006. Immunohistochemical staining for CXCR4 was performed on all available brain metastasis biopsy specimens.ResultsThe incidence of brain metastases from CRC was 2.3%. Left-sided primary colon tumors predominated. The majority of patients had pulmonary metastases at the time brain metastases were identified, and those with preexisting pulmonary metastases had progression of that disease. All patients were symptomatic from brain metastases, and the cerebellum was the most common area of brain involvement. Immunohistochemical analysis confirmed strong expression of CXCR4 in all brain metastases sampled.ConclusionThe incidence of brain metastases from CRC is low. Primary tumor in the left colon, long-standing pulmonary metastases, especially those with recent progression, and CXCR4 expression by tumor cells are all associated with increased risk of brain metastases. Increased survival among patients with metastatic CRC will likely result in an increased incidence of brain metastases. Further characterization of the role of tumor and host factors might yield better insight into the development, and potentially the prevention, of this devastating situation. |
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