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Abstract
PURPOSE:
It is important to take into account potential prognostic factors to select patients with brain metastasis from colorectal cancer (CRC) who will benefit from active neurosurgical treatment. Therefore, we experimentally investigated our single institutional data to develop a novel CRC-specific graded prognostic assessment (GPA) and to help clinicians determine the optimal management.

METHODS AND MATERIALS:
We retrospectively reviewed the records of 107 patients with brain metastases from CRC who received any kind of treatment in our hospital and had sufficient clinical information.

RESULTS:
The median overall survival was 5.2 months, and the 1- and 2-year overall survival rates were 23.7 and 6.6%, respectively. Multivariate analysis revealed that the number of brain metastases ≥ 6, presence of neurologic symptoms, and elevated serum carcinoembryonic antigen (≥ 30 ng/ml) were the independent prognostic factors for poor overall survival, while performance status was not. Based on this, we developed the CRC-specific GPA index and stratified patients into three categories. The median overall survival for patients with GPA scores of 0-0.5, 1.0-1.5, and 2.0-2.5 was 2.3, 4.3, and 12.7 months, respectively (p < 0.001). Surgery or stereotactic radiosurgery ± whole-brain radiotherapy showed a better survival than palliative whole-brain radiotherapy alone in patients with high GPA scores.

CONCLUSIONS:
We developed a novel CRC-specific GPA index, which could help physicians to stratify patients with brain metastases. Further efforts are needed to validate and improve this index.

Author information

Kim BH1,2, Park HJ3, Kim K4, Han SW5, Kim TY5, Jeong SY6, Park KJ6, Chie EK7.
1
Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
2
Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
3
Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Republic of Korea.
4
Department of Radiation Oncology, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea. kyubokim.ro@gmail.com.
5
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
6
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
7
Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. ekchie93@snu.ac.kr.