P03.02 Risk of leptomeningeal dissemination in patients treated with postoperative stereotactic radiotherapy of brain metastases

Abstract Background There is a body of evidence that the risk of leptomeningeal dissemination (LMD) is increased in the postoperative stereotactic radiotherapy (SRT) of brain metastases (BM) compared to adjuvant whole brain radiotherapy (WBRT). The proposed mechanism is an iatrogenic tumor dissemination into the cerebrospinal fluid at time of surgery. Including a wider volume of meningeal wall and the entire surgical track in the definition of the postoperative SRT clinical target volume (CTV) to decrease LMD is still controversial. The aim of this study was to retrospectively analyze the outcome of adjuvant SRT targeted at resection cavities of BM without previous WBRT. MATERIAL / METHODS We reviewed 70 patients treated with postoperative SRT for BM. Stereotactic planning computed tomography and planning MRI were imported into iPlan RT image software for image registration and TV delineation. The CTV consisted of any residual enhancement and all resected cavity including a safety margin of 1 to 2 mm. Only in cases of superficial initial tumor with meningeal contact was the CTV enlarged to the adjacent meningeal wall, but never included edema or the entire surgical track. Patients underwent regular follow-up MRI. The cumulative incidence rates of LMD was retrospectively calculated as well as patterns of failure. RESULTS The most common histological type was non small cell lung cancer in 61.4%. There were 38.6% infratentorial locations and 37.2 % superficial lesions. En bloc resection was achieved in 60% and compete resection in 75.7%. After a median imaging follow up time of 16.7 months, 54.3% of patients experienced distant brain failure. LMD occurred in 9 of 70 patients (12.9 %) at a median time of 10.7 months. Survival without LMD was 88% at 1 year (IC 95% 79%-97%) and 82% at 2years (IC 95% 72%-94%). In three quarter of cases, LMD interested superficial lesions. In univariate analysis, survival rates without LMD at 1 year for superficial and deep lesions were 88 % and 94 %, respectively (p=0.49). We report only one recurrence in the surgical track (1.42%). CONCLUSION The risk of LMD was comparable to the literature (11–17%). Superficial lesions were slightly more likely to relapse in the meninges, but it was non-significant. The risk of recurrence in the surgical track is negligible. Our results do not support the current guidelines recommending the systematic inclusion of the surgical track and the related meninges in the CTV.

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RADI-05. FRACTIONATED TREATMENT OF BRAIN METASTASES WITH GAMMA KNIFE ICON

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz014.098 ◽

2019 ◽

Vol 1 (Supplement_1) ◽

pp. i22-i22

Author(s):

Jameson Mendel ◽

Ankur Patel ◽

Toral Patel ◽

Robert Timmerman ◽

Tu Dan ◽

...

Keyword(s):

Brain Metastasis ◽

Brain Metastases ◽

Gamma Knife ◽

Local Control ◽

Stereotactic Radiotherapy ◽

Tumor Volume ◽

Univariate Analysis ◽

Local Failure ◽

Fractionated Stereotactic Radiotherapy

Abstract PURPOSE/OBJECTIVE(S): Stereotactic radiosurgery with Gamma Knife is a common treatment modality for patients with brain metastasis. The Gamma Knife ICON allows for immobilization with an aquaplast mask, permitting fractionated treatments. We describe one of the first experiences utilizing this technique with brain metastasis and evaluate outcomes. MATERIALS/METHODS: From June 2017 to November 2018, 29 patients with 43 separate intracranial lesions were treated with fractionated stereotactic radiotherapy using the gamma knife ICON at a single institution. Patients received between 20–30 Gy in 3–5 fractions with no margin over the course of 5 to 23 days. Local control was physician assessed. Local failure over time was modeled using cumulative incidence; lesions were censored at last radiographic follow up. RESULTS: Median tumor volume and prescription isodose was 7.7 cm3 (range 0.3–43.9) and 50% (range 40–65), respectively. Median radiographic follow-up was 7 months and median survival was 9 months. Radiation necrosis occurred in 3/3 patients treated with 27 Gy in 3 fractions, one requiring therapeutic resection. Incidence of local failure for all treated lesions was 9% at 1 year. Tumor volume >7 cm3 was associated with local failure on univariate analysis (p=0.025). 100% (2/2) lesions treated with 20 Gy in 5 fractions developed local recurrence. CONCLUSION: Fractionated stereotactic radiotherapy with the Gamma Knife ICON provides excellent local control for small and large brain metastases with minimal toxicity. Tumors >7 cm3 should receive at least 30 Gy in 5 fractions for optimal control. Treatment with 27 Gy in 3 fractions appears to have high rates of treatment related toxicity and should be avoided.

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Surgical management of lateral-ventricle metastases: report of 29 cases in a single-institution experience

Journal of Neurosurgery ◽

10.3171/2009.7.jns09571 ◽

2010 ◽

Vol 112 (5) ◽

pp. 1046-1055 ◽

Cited By ~ 11

Author(s):

Wael Hassaneen ◽

Dima Suki ◽

Abhijit L. Salaskar ◽

David M. Wildrick ◽

Frederick F. Lang ◽

...

Keyword(s):

Lateral Ventricle ◽

Univariate Analysis ◽

Survival Rates ◽

Postoperative Mortality ◽

En Bloc Resection ◽

Survival Duration ◽

Karnofsky Performance Scale ◽

Leptomeningeal Disease ◽

Recurrence Rates ◽

En Bloc

Object The aim of this study was to review the outcome of patients undergoing surgery for treatment of lateral-ventricle metastases. Methods Imaging information and chart reviews of operative reports were used to conduct a retrospective analysis in 29 patients who underwent resection of lateral-ventricle metastases at the authors' institution between 1993 and 2007. Clinical and neurosurgical outcomes and recurrence rates were studied. Results The mean patient age was 56 years (range 20–69 years); 66% of patients were male. Single intraventricular metastases occurred in 69% of patients, and 55% of them had systemic metastases. The 30-day postoperative mortality rate was 7%. There was intracerebral tumor recurrence in 41% of patients, with 1 patient undergoing a second operation for this. The median postoperative survival duration for 28 patients (excluding 1 patient with preoperative leptomeningeal disease) was 11.7 months; the 3- and 5-year survival rates were 17 and 11%, respectively. Univariate analysis identified factors significantly influencing survival, including the preoperative Karnofsky Performance Scale (KPS) score (p = 0.02), the number of cerebral metastases (p = 0.02), the presence of primary renal cell carcinoma (RCC) (p = 0.02), and the resection method (en bloc vs piecemeal; p = 0.05). The presence of extracranial metastases did not significantly influence survival. Multivariate analysis showed that the preoperative KPS score (p = 0.002), the presence of primary RCC (p = 0.039), and the resection method (en bloc vs piecemeal; p = 0.008) correlated significantly with survival time. Conclusions Surgery is an important component in the management of intraventricular metastases. To the authors' knowledge, this is the first study focusing totally on resection of lateral-ventricle metastases. The authors found that patients with primary RCC, those with a favorable preoperative KPS score, and those who underwent en bloc resection had a better outcome than others.

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Change in Abdominal Aortic Aneurysm Sac Diameter After Endovascular Repair: A Single-Center Experience From Taiwan

Journal of Endovascular Therapy ◽

10.1177/15266028211068755 ◽

2022 ◽

pp. 152660282110687

Author(s):

Hsien-Wei Tseng ◽

Po-Ya Chang ◽

Chin-Hao Chang ◽

I-Hui Wu ◽

Ron-Bin Hsu ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Adverse Events ◽

Survival Rates ◽

Incidence Rates ◽

Single Center Experience ◽

Maximal Diameter ◽

Abdominal Aortic ◽

Diameter Change

Purpose: The purpose of this study was to investigate the change in the diameter of infrarenal abdominal aortic aneurysm (AAA) sacs after endovascular aortic repair (EVAR) in Taiwanese patients and to depict its association with clinical outcomes. Materials and Methods: This retrospective cohort study was conducted on patients who underwent EVAR for infrarenal AAA between January 2011 and December 2016. All preoperative and follow-up computed tomography (CT) images were reviewed. Postoperative CT angiography was arranged after 1 month and annually thereafter. The maximal diameter on the axial plane and the maximal diameter perpendicular to the centerline on the coronal and sagittal planes were measured. The study examined post-EVAR sac diameter change over time and compared the differences in adverse events (AEs) among groups. Results: The survey included a total of 191 patients with a median follow-up duration of 2.5 (interquartile range: 1.1–2.9) years. Overall survival rates at 1, 2, and 5 years were 92%, 81%, and 76%, respectively. According to their last CT scans, the patients were categorized into 3 groups as follows: shrinkage, stationary, and enlargement, which comprised 58 (30.4%), 118 (61.8%), and 15 (7.9%) patients, respectively. Pre-EVAR characteristics and sac diameters were similar among the groups. Sac shrinkage was exclusively observed in the first 2 years, whereas sac enlargement developed at all follow-up periods. Patients with sac enlargement had higher incidence rates of endoleaks, complications, and reintervention than the other groups. Conclusion: Based on our observations, post-EVAR sac shrinkage only occurs in the first 2 years; however, post-EVAR sacs may enlarge at any point and even after 5 years. In our study, patients with sac enlargement had higher rates of adverse events and reintervention.

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Pineocytoma with diffuse dissemination to the leptomeninges

Rare Tumors ◽

10.4081/rt.2011.e53 ◽

2011 ◽

Vol 3 (4) ◽

pp. 163-165 ◽

Cited By ~ 4

Author(s):

Caitlin Gomez ◽

Jeffrey Wu ◽

Whitney Pope ◽

Harry Vinters ◽

Antonio DeSalles ◽

...

Keyword(s):

Radiation Therapy ◽

Stereotactic Radiotherapy ◽

Leptomeningeal Dissemination ◽

Resonance Imaging ◽

Pineal Parenchymal Tumors ◽

Craniospinal Radiation ◽

Long Term Follow Up ◽

Magnetic Resonance Imaging Mri

Pineal parenchymal tumors are rare. Of the three types of pineal parenchymal tumors, pineocytomas are the least aggressive and are not known to diffusely disseminate. In this paper, we report the successful treatment of a case of pineocytoma with diffuse leptomeningeal relapse following initial stereotactic radiotherapy. A 39-year-old female presented with headaches, balance impairment, urinary incontinence, and blunted affect. A pineal mass was discovered on magnetic resonance imaging (MRI). A diagnosis of pineocytoma was established with an endoscopic pineal gland biopsy, and the patient received stereotactic radiotherapy. Ten years later, she developed diffuse leptomeningeal dissemination. The patient was then successfully treated with craniospinal radiation therapy. Leptomeningeal spread may develop as late as 10 years after initial presentation of pineocytoma. Our case demonstrates the importance of long-term follow-up of patients with pineal parenchymal tumors following radiation therapy, and the efficacy of craniospinal radiation in the treatment of leptomeningeal dissemination.

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Sarcoligo: Impact of local ablative treatment of oligometastatic sarcomas on overall survival.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.10042 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 10042-10042

Author(s):

Juliette Thariat ◽

Laurence Moureau-Zabotto ◽

Nicolas Penel ◽

Antoine Italiano ◽

Jacques-Olivier Bay ◽

...

Keyword(s):

Overall Survival ◽

Lung Metastases ◽

Univariate Analysis ◽

Survival Rates ◽

Locoregional Treatment ◽

Metastatic Sites ◽

The Impact

10042 Background: 40-50% of sarcomas become metastatic. Median survival of metastatic patients has improved over time. The probably multifactorial reasons for such improvement are not fully clear. Noteworthy, for patients with a controlled primary and a limited number of lung metastases, complete resection of their metastases yields survival rates of up to 40% at three years. Advances in surgery, radiotherapy and radiofrequency have fostered the use of local treatments for various metastatic sites (lung, liver, spine...). Methods: A multicentric retrospective study of the Groupe Sarcome Francais (GSF-GETO); approved by the nationally-review board and ethical committee, was conducted to assess the impact of local ablative treatment on overall survival. Patients who had had oligometastases (any site, 1-5 synchronous metastases) at diagnostic or during the course of disease between 2000 and 2010 were included. Results: Median age of the 243 oligometastatic sarcoma patients was 53 years-old (11-86). Patients had grade I, II and III in 7.5%, 29.6% and 63.3% of cases, respectively with various histologies. 69% of patients underwent local ablative treatment of metastases. Median follow-up was 59 months (4-212) for living patients. Median overall survival was 51 months (1-348). On univariate analysis, grade, histology, absence of chemotherapy, local ablative treatment (surgery, irradiation, radiofrequency or chemoembolisation) correlated with survival but not age or site of oligometastasis. On multivariate analyses, grade (hazard ratio HR 0.12 [CI95 0.3-0.6]) and local ablative treatment (HR 3.8 [CI95 2.1-7.1]) remained significant. Conclusions: Local ablative treatment of metastases is associated with better survival in sarcoma patients with oligometastatic disease. The role of the locoregional treatment of metastases and its impact on quality of life should be assessed prospectively.

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Survival of melanoma patients with brain metastases treated with ipilimumab combined with stereotactic radiosurgery.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20019 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20019-e20019

Author(s):

Karim Tazi ◽

Cody Chiuzan ◽

Keisuke Shirai

Keyword(s):

Overall Survival ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Performance Status ◽

Survival Rates ◽

Stage Iv ◽

Rank Test ◽

Group A ◽

Stage Iv Melanoma

e20019 Background: Historically, melanoma with brain metastases has a poor prognosis and is a major contributor to patient morbidity and mortality. Recently, the use of ipilimumab has improved overall survival in stage IV melanoma; however, the outcome of patients with brain metastases remains unclear. In this retrospective medical record review, we report the outcome of patients with stage IV melanoma with brain metastases treated with ipilimumab and brain stereotactic radiosurgery (SRS). Methods: All patients with metastatic melanoma treated with ipilimumab from April 2010 to March 2012 were identified and stratified by presence (A) or absence (B) of brain metastases. All patients with brain metastases received SRS. Performance status, dates of stage IV diagnosis, brain SRS and cycle 1 of ipilimumab administration were recorded. We used the Disease Specific Graded Prognostic Assessment (DS-GPA) to estimate the predicted survival. Overall survival was defined as time (months) from the date of the stage IV diagnosis and the time of ipilimumab administration to death or last follow-up. Survival curves were estimated using the Kaplan-Meier method, and compared using a two-tailed log-rank test. Results: Twelve of 30 patients treated with ipilimumab had brain metastases. Median age was 66 years. Median DS-GPA score was 3 (estimated mean survival of 8.7 months). Four patients (33%) in group A and 6 patients (33%) in group B died as of last follow-up. Median number of SRS treatment was 1 (1 to 4), and median total treated lesions were 3 (1-14). Median survivals from date of Stage IV for A and B were 29.1 and 32.9 months, respectively (p=0.67). The estimated 2 year survival rates from date of cycle 1 ipilimumab administration for A and B were 58% (95% CI: 32-100%) and 55% (95% CI: 32-93%), respectively. Ten out of 12 patients in group A maintained an ECOG PS of 0-1 as of last follow-up. Conclusions: Survival of patients with melanoma brain metastases treated with ipilimumab combined with SRS may be comparable to patients without brain metastases. Ipilimumab and SRS do not seem to adversely impact quality of life.

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Adult Granulosa Cell Tumors of the Ovary: A Retrospective Study of 36 FIGO Stage I Cases with Emphasis on Prognostic Pathohistological Features

Analytical Cellular Pathology ◽

10.1155/2018/9148124 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11

Author(s):

Emina Babarović ◽

Ivan Franin ◽

Marko Klarić ◽

Ani Mihaljević Ferrari ◽

Ružica Karnjuš-Begonja ◽

...

Keyword(s):

Retrospective Study ◽

Univariate Analysis ◽

Survival Rates ◽

Disease Free Survival ◽

Figo Stage ◽

Free Survival ◽

Granulosa Cell Tumors ◽

Diffuse Growth ◽

Disease Free

Objective. Adult granulosa cell tumors (AGCTs) represent 2%–5% of all ovarian malignancies. The aim of this study was to analyze clinical and pathohistological parameters and their impact on recurrence, overall, and disease-free survival in FIGO stage I AGCT patients. Methods. The tumor specimens analyzed in this retrospective study were obtained from a total of 36 patients with diagnosis of ovarian AGCT surgically treated at the Department of Gynecology, Rijeka University Hospital Centre, between 1994 and 2012. Clinical, pathological, and follow-up data were collected. Results. The mean age at diagnosis was 54.5 years with a range of 24–84. The majority of the patients, 30 (83%), were in FIGO stage IA, 3 (8%) in stage IC1, 1 (3%) in stage IC2, and 2 (6%) in stage IC3. During follow-up period (median 117.5 months, range 26–276), recurrence occurred in 4 patients (12%) with 2 deaths of the disease recorded. In univariate analysis, the 5-year survival rates were significantly shorter in patients with FIGO substage IC (p=0.019), with positive LVSI (p=0.022), with presence of necrosis (p=0.040), and with hemorrhage (p=0.017). In univariate analysis, the 5-year disease-free survival rates were significantly shorter in patients treated with fertility surgery (p=0.004), with diffuse growth pattern (p=0.012), with moderate and severe nuclear atypia (p=0.032), and with presence of hemorrhage (p=0.022). FIGO substage IC proved to be independent predictor for recurrence (OR = 16.87, p=0.015, and OR = 23.49, p=0.023, resp.) and disease-free survival (p=0.0002; HR 20.84, p=0.02) at the uni- and multivariate analyses. Conclusions. FIGO substage IC is predictive of recurrence and disease-free survival in patients with early-stage AGCTs. LVSI, presence of necrosis and hemorrhage, diffuse growth pattern, and nuclear atypia in AGCTs seem to be associated with overall and disease-free survival, so these pathological features should be taken into consideration when managing patients with AGCT.

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Brain Metastases from Esophageal Squamous Cell Carcinoma: Clinical Characteristics and Prognosis

Frontiers in Oncology ◽

10.3389/fonc.2021.652509 ◽

2021 ◽

Vol 11 ◽

Author(s):

Linlin Xiao ◽

Yvonne M. Mowery ◽

Brian G. Czito ◽

Yajing Wu ◽

Guangbin Gao ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Esophageal Squamous Cell Carcinoma ◽

Brain Metastases ◽

Supportive Care ◽

Cell Carcinoma ◽

Squamous Cell ◽

Clinical Characteristics ◽

Survival Rates ◽

Locoregional Treatment

PurposeDue to the low incidence of intracranial disease among patients with esophageal cancer (EC), optimal management for these patients has not been established. The aim of this real-world study is to describe the clinical characteristics, treatment approaches, and outcomes for esophageal squamous cell carcinoma (ESCC) patients with brain metastases in order to provide a reference for treatment and associated outcomes of these patients.MethodsPatients with ESCC treated at the Fourth Hospital of Hebei Medical University between January 1, 2009 and May 31,2020 were identified in an institutional tumor registry. Patients with brain metastases were included for further analysis and categorized by treatment received. Survival was evaluated by the Kaplan-Meier method and Cox proportional hazards models.ResultsAmong 19,225 patients with ESCC, 66 (0.34%) were diagnosed with brain metastases. Five patients were treated with surgery, 40 patients were treated with radiotherapy, 10 with systemic therapy alone, and 15 with supportive care alone. The median follow-up time was 7.3 months (95% CI 7.4-11.4). At last follow-up, 59 patients are deceased and 7 patients are alive. Median overall survival (OS) from time of brain metastases diagnosis was 7.6 months (95% CI 5.3-9.9) for all cases. For patients who received locoregional treatment, median OS was 10.9 months (95% CI 7.4-14.3), and survival rates at 6 and 12 months were 75.6% and 37.2%, respectively. For patients without locoregional treatment, median OS was 3.0 months (95% CI 2.5-3.5), and survival rates at 6 and 12 months were 32% and 24%, respectively. OS was significantly improved for patients who received locoregional treatment compared to those treated with systematic treatment alone or supportive care (HR: 2.761, 95% CI 1.509-5.053, P=0.001). The median OS of patients with diagnosis-specific graded prognostic assessment (DS-GPA) score 0-2 was 6.4 months, compared to median OS of 12.3 months for patients with DS-GPA >2 (HR: 0.507, 95% CI 0.283-0.911).ConclusionBrain metastases are rare in patients with ESCC. DS-GPA score maybe a useful prognostic tool for ESCC patients with brain metastases. Receipt of locoregional treatment including brain surgery and radiotherapy was associated with improved survival.

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Predictors of leptomeningeal disease following hypofractionated stereotactic radiotherapy for intact and resected brain metastases

Neuro-Oncology ◽

10.1093/neuonc/noz144 ◽

2019 ◽

Vol 22 (1) ◽

pp. 84-93 ◽

Cited By ~ 9

Author(s):

Timothy K Nguyen ◽

Arjun Sahgal ◽

Jay Detsky ◽

Eshetu G Atenafu ◽

Sten Myrehaug ◽

...

Keyword(s):

Brain Metastases ◽

Stereotactic Radiotherapy ◽

Median Overall Survival ◽

Multivariable Analysis ◽

Leptomeningeal Disease ◽

Hypofractionated Stereotactic Radiotherapy ◽

Increased Risk ◽

Intact Brain ◽

Intracranial Lesions

Abstract Background The objective was to evaluate the risk and predictors of developing leptomeningeal disease (LMD) in patients with brain metastases treated with 5-fraction hypofractionated stereotactic radiotherapy (HSRT). Methods Patients treated with HSRT for intact brain metastases and/or surgical cavities were reviewed from a prospectively maintained database. Radiographic patterns of LMD were classified as focal classical, diffuse classical, focal nodular, and diffuse nodular. Results HSRT was delivered, most commonly 30 Gy in 5 fractions, to 320 intracranial lesions (57% intact and 43% surgical cavities) in 235 patients. The median follow-up was 13.4 months (range, 0.8 to 60 mo). LMD developed in 19% of patients with a 1-year LMD rate of 12%. From the diagnosis of LMD, the median overall survival (OS) was 3.8 months (range, 2–20.8 mo). The most common LMD pattern was diffuse nodular (44%). No difference in OS was observed between LMD patterns (P = 0.203). Multivariable analysis identified surgical cavities at significantly higher risk of LMD compared with intact lesions (odds ratio [OR] = 2.30, 95% CI: 1.24, 4.29, P = 0.008). For cavities, radiosensitive tumors (OR = 2.35, 95% CI: 1.04, 5.35, P = 0.041) predicted for LMD, while, for intact metastases, patients receiving treatment with targeted agents or immunotherapy (TA/I) were at lower risk (OR = 0.178, 95% CI: 0.04, 0.79, P = 0.023). Conclusions Patients who had a brain metastasis resected were at an increased risk of LMD. OS was poor despite treatment of LMD, and no differences in OS based on the pattern of LMD was observed. Treatment with TA/I was observed to be protective against LMD and requires further study.

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Colorectal cancer survivorship statistics: A Veterans Affairs Central Cancer Registry analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.e267 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. e267-e267 ◽

Cited By ~ 1

Author(s):

Leah L. Zullig ◽

Valerie Smith ◽

Susanne Danus ◽

Merritt Schnell ◽

Jennifer Lindquist ◽

...

Keyword(s):

Survival Data ◽

Survival Rates ◽

Distal Colon ◽

Tumor Location ◽

Support Service ◽

Proximal Colon ◽

Incidence Rates ◽

Colon 26 ◽

And Gender

e267 Background: Our objective was to evaluate VA CRC incidence and survival and compare with the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data. Methods: Data were obtained from VACCR for veterans diagnosed/treated in VA for incident CRC during fiscal years (FY) 2009-2012. Using VHA Support Service Center information about the distribution of VA healthcare system enrollees for corresponding years, we adjusted incidence rates for age and gender to the underlying VA population. Survival data were available through January 2015; thus, patients in the analysis had 3-6 years of follow-up data and were censored accordingly. CRC incidence and survival among VA patients was compared to projected national 2014 CRC-specific SEER and supporting data sources. Results: From FY 2009-2012, 12,551 patients (2.6% women; 97.4% men) were in the analytic cohort. Among VACCR patients, the most common tumor location was proximal colon (38%), followed by rectum (31%), distal colon (26%), and other colon (5%). This is comparable to SEER, in which proximal colon and rectum are most common. Among patients in the VACCR, SEER summary stage distribution was: 44% local, 36% regional, 17% distant and 4% unknown. This also aligns with SEER, in which approximately 40% of CRC cases are diagnosed locally. Mirroring SEER, overall VA CRC incidence rate decreased from 0.22 to 0.16 cases per 1,000 veterans in FYs 2009 and 2012. Evaluating survival, median follow-up time was 3.3 years among veterans. The 3-year survival rate for VA patients was 65.9%. Overall 3-year survival is slightly higher for rectal (66.4%) than for colon (65.6%). This is comparable to 5-year SEER survival rates (66.5% and 64.2% for rectal and colon, respectively). Also consistent with SEER, VA CRC patients < 65 have higher rates of 3-year survival than patients > 65 years (74.6% vs. 58.5%, respectively). Conclusions: VACCR data indicate that CRC incidence and survival in FY 2009-2012 approximated SEER projections during a similar timeframe. This suggests that, although VA patients are more complex than the general population, they are diagnosed with comparable CRC locations and stages.

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