An uncommon case of colon cancer with cns involvement

SESSION TITLE: Critical Care Case Report Posters 46 SESSION TYPE: Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: Colorectal cancer is the third most common cancer and the fourth leading cause of cancer-related deaths in the world. Men are more frequently affected, and 25% of patients present with distant metastases on diagnosis, and 25% suffer metastases further on. Metastatic disease usually develops liver or lung metastases. Brain metastases (BM) for this type of cancer are rare and optimal treatment remains undefined, we present an uncommon case of colon cancer metastasized to the brain which was treated with stereotactic surgery. CASE PRESENTATION: A 62-year-old male with a past medical history of hypertension, chronic kidney disease, hemorrhagic stroke, colon cancer T4aN1bM0 (status post extended left hemicolectomy and 12 cycles of FOLFOX chemotherapy) diagnosed one year prior to admission presented to the emergency department with fever, diarrhea chills, and altered mental status. Vital signs with BP of 60/30, HR 130, RR 25, refractory to IV Fluid resuscitation and treated for septic shock. Severe leukocytosis and a thorough workup revealed the source being c. difficile diarrhea. The rest of the cultures were negative, other sources were ruled out. On day 3 of admission, he developed a worsening mental status. CT Brain noted a 1.7 x 1.5cm hypodense mass with calcifications related to the region of the right external capsule with adjacent vasogenic edema. CT lumbar spine with mild acute compression fracture superior endplate L2 vertebral body without retropulsion. Further workup with MRI showed 18 x 15 mm right lateral inferior deep frontal lobe and sub-insular region inhomogeneous enhancing mass, surrounded by edema with some mild regional mass effect, which was consistent with metastatic lesions. The patient was evaluated by neurosurgery, however, did not require any intervention. He was evaluated by radio/oncology and oncology and underwent stereotactic radiosurgery without complications. The patient would follow up as an outpatient for PET /CT and continuity of treatment. DISCUSSION: The incidence of BM ranges from 0.6-4.2% usually occurring in advanced stages of the disease and is common to be concomitant with liver or lung metastasis as well. Clinical presentation can range from asymptomatic to seizures and focal neurological signs. In our case, it is uncertain whether the altered mental status was related to the BM. The prognosis of colorectal cancer metastatic to the brain is poor with a median survival of 4-6 weeks for untreated ones, and 6-9 months in active treatment. Local treatment approaches include neurosurgical resection, whole-brain radiation therapy, stereotactic radiosurgery, and hypofractionated stereotactic radiosurgery. The choice is determined by the disease, patient performance status, site, and size of metastasis, however, there is limited data on the optimal treatment for these patients. CONCLUSIONS: Colorectal cancer with brain metastases is a rare occurrence that is related to poor prognosis. Multiple treatment options exist, however, data on long-term prognosis is limited; more research is needed to create guidelines for it. REFERENCE #1: Navarria P, Minniti G, Clerici E, et al. Brain metastases from primary colorectal cancer: is radiosurgery an effective treatment approach? Results of a multicenter study of the radiation and clinical oncology Italian association (AIRO). Br J Radiol. 2020;93(1116):20200951. doi:10.1259/bjr.20200951 REFERENCE #2: Müller S, Köhler F, Hendricks A, et al. Brain Metastases from Colorectal Cancer: A Systematic Review of the Literature and Meta-Analysis to Establish a Guideline for Daily Treatment. Cancers (Basel). 2021;13(4):900. Published 2021 Feb 21. doi:10.3390/cancers13040900 REFERENCE #3: Sanghvi, S.M., Lischalk, J.W., Cai, L. et al. Clinical outcomes of gastrointestinal brain metastases treated with radiotherapy. Radiat Oncol 12, 43 (2017). https://doi.org/10.1186/s13014-017-0774-3 DISCLOSURES: No relevant relationships by Mariel Duchow No relevant relationships by Shaun Isaac No relevant relationships by Kristina Menchaca No relevant relationships by Catherine Ostos No relevant relationships by Amit Sah No relevant relationships by Virginia Velez Quinones