EPID-14. PATTERNS OF CARE AND PROGNOSTIC FACTORS FOR PATIENTS WITH BRAIN METASTASES FROM COLON CANCER: A REAL-WORLD STUDY

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Abstract BACKGROUND Brain metastases (BMs) from colon cancer (CC) have limited published literature. This work sought to examine patterns of care and prognostic factors for patients with CC BMs. METHODS A retrospective study was conducted on patients with CC BMs in the National Cancer Database between 2010-2020 and reported using STROBE guidelines. Treatment was stratified into receipt of stereotactic radiosurgery only (SRS), whole brain radiation only (WBRT), systemic therapy only (Sys), combination therapy, and no brain-directed treatment (NoTx). Median overall survival (mOS) and prognostic factors were determined using multivariate cox proportional hazards adjusting for age, sex, race/ethnicity, insurance, Charlson-Deyo score (CDS), concurrent metastases (CMs), and treatment. Outcomes were reported as hazard ratio (HR) and 95% confidence intervals. RESULTS Among 1,383 BMs patients, median age was 64.0 years (IQR 56.0-73.0). 46.4% were female and 81.2% were White. Overall mOS (95% CI) was 5.6 months (4.5-6.2). 26.1% had bone, 71.5% had lung and 72.4% had liver CMs. 24.4% underwent WBRT+Sys, 22.6% NoTx, 18.5% Sys, 14.8% SRS+Sys, 14.7% WBRT, and 5.0% SRS. Patients who underwent SRS+Sys had the highest mOS of 14.4 months (12.8-16.3) followed by Sys: 11.6 months (8.6-13.4), WBRT+Sys: 9.5 months (8.5-10.9), SRS: 3.2 months (2.5-4.4), WBRT: 2.5 months (2.2-2.8), and NoTx: 2.5 months (2.2-2.8) (P<0.001). Patients treated with WBRT+Sys (HR:1.2, 1.0-1.5, P=0.028), SRS alone (HR:1.8, 1.4-2.5, P<0.001), WBRT alone (HR:3.6, 2.9-4.4, P<0.001), NoTx (HR:2.5, 2.0-3.0, P<0.001) was associated with significantly lower survival than SRS+Sys. Patients treated at non-academic facilities (HR:1.1, 1.0-1.3, P=0.038), with Medicare-insurance (HR:1.2, 1.1-1.5, P=0.013) and with left-sided mCC (HR:0.8, 0.7-0.9, P<0.001) had lower survival. CONCLUSIONS SRS+Sys was associated with the highest survival in patients with CC BMs, however only 14.8% received it. Notably, 22.6% of patients received NoTx. Further prospective studies exploring factors behind heterogeneity in clinical care are warranted.

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