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Gastrointestinal Cancer and Brain Metastases
Because of the rising incidence of brain metastases secondary to gastrointestinal (GI) cancer, Go and colleagues1 published a comprehensive review of the incidence, prevalence, epidemiology, risk factors, management, and prognosis of brain metastasis arising from esophageal, gastric, gallbladder, pancreatic, small bowel, and colorectal cancer.


Background

Metastatic brain tumors represent 20% to 40% of all intracranial neoplasms and are found most frequently in association with lung cancer (50%) and breast cancer (12%). Although brain metastases occur in <4% of all tumors of the GI tract, the incidence of GI brain metastasis is rising in part due to more effective systemic treatments and prolonged survival of patients with GI cancer.


Method

Data were collected from 25 studies (11 colorectal, 7 esophageal, 2 gastric, 1 pancreatic, 1 intestinal, 3 all-inclusive GI tract cancer) and 13 case reports (4 pancreatic, 4 gallbladder, and 5 small bowel cancer).


Findings

Brain metastases are found in 1% of colorectal cancer, 1.2% of esophageal cancer, 0.62% of gastric cancer, and 0.33% of pancreatic cancer cases. Surgical resection with whole brain radiation therapy (WBRT) has been associated with the longest median survival (38.4-262 weeks) compared with surgery alone (16.4-70.8 weeks), stereotactic radiosurgery (20-38 weeks), WBRT alone (7.2-16 weeks), or steroids (4-7 weeks). Survival in patients with brain metastasis from GI cancer was found to be diminished compared with metastases arising from the breast, lung, or kidney. Prolonged survival and improvement in clinical symptoms have been found to be best achieved with surgical resection and WBRT.


The authors conclude that although early treatment has been linked to prolonged survival and improved quality of life, brain metastases represent a late manifestation of GI cancers and remain an ominous sign.1


ManageCRC.com Commentary

Before the advent of modern systemic therapy for GI cancers, most patients lived for only weeks or months. Late onset metastases in sites such as the brain or central nervous system rarely developed; the patient died before such metastases could occur. Recent advances in therapies for GI cancers have resulted in longer disease-free intervals and better overall survival. Because survivors are living longer, clinicians are beginning to see the emergence of brain metastases from cancers where they were rarely seen in the past. For this reason, it is important for oncology clinicians to routinely assess GI cancer survivors for signs and symptoms of brain metastases, including gait disturbances, altered mental status or personality changes, and focal neurologic deficits. Memory loss and seizures are additional clinical signs, but are less common.


Reference
  1. Go PH, Klaassen Z, Meadows MC, Chamberlain RS. Gastrointestinal cancer and brain metastasis: A rare and ominous sign. Cancer 2011;117:3630–3640. doi:10.1002/cncr.25940 Link to abstract http://www.ncbi.nlm.nih.gov/pubmed/21319152


Article Created On : 9/8/2011 1:33:19 PM             Article Updated On : 9/8/2011 1:33:19 PM