Current understanding and management of brain metastasis from colorectal cancer. A review

Colorectal cancer (CRC) ranks as the third most diagnosed cancer worldwide and the second leading cause of cancer-related death. Although relatively rare, brain metastases from CRC (BMCRC) have been linked to poor prognosis and reduced survival rates. The incidence of BMCRC is increasing, possibly because of improved diagnostic techniques and prolonged patient survival due to advances in systemic treatments.

A systematic literature review was conducted following PRISMA guidelines, utilizing databases such as PubMed, Embase, and the Cochrane Library. Eligible studies included original research articles related to BMCRC published in English from January 2000 to June 2025. Two independent reviewers screened and extracted data on study characteristics, treatment modalities, outcomes, and risk factors.

BMCRC is less common than liver and lung metastases, but its incidence is increasing. Risk factors include molecular subtype (particularly KRAS mutation), location of the primary (rectal or right-sided) and the presence of lung or liver metastases. Symptoms are often nonspecific and include neurological deficits and headaches. Systematic brain scans are not currently recommended but may be suggested for patients with risk factors. Treatments are not standardized and include neurosurgery, radiotherapy (stereotactic radiosurgery [SRS] and whole-brain radiotherapy [WBRT]) and systemic therapies (chemotherapy, targeted therapies and immunotherapy). Surgical resection remains the treatment of choice when possible.

BMCRC is challenging because of its rarity and complex management. Recent advances in systemic therapies and diagnostic techniques have improved patient outcomes. Future research should focus on novel therapeutic approaches and biomarker validation to enhance early detection and personalize treatment strategies.