Objective:

To report a rare case of cerebral metastasis in a patient with wild-type KRAS/BRAF colorectal cancer after standard treatment, highlighting the need to reassess the risk of CNS dissemination in patients with favorable molecular profiles.

Key Findings:

• Cerebral metastasis occurred despite initial systemic remission and favorable molecular profile, suggesting a need for reevaluation of risk assessments.
• The patient had a microsatellite-stable tumor with low tumor mutational burden and wild-type KRAS/NRAS/BRAF, challenging the notion of low CNS risk.
• Delayed CNS metastasis challenges the assumption that molecularly favorable CRC has a low risk for CNS dissemination, necessitating a review of surveillance protocols.

Interpretation:

This case suggests that even in patients with low-risk molecular profiles, there may be a potential for delayed CNS metastasis, indicating a need for revised surveillance strategies tailored to individual patient risk factors.

Limitations:

• Single case study limits generalizability of findings, and potential biases in treatment response should be acknowledged.
• Lack of comprehensive data on larger cohorts with similar molecular profiles restricts broader applicability of results.

Conclusion:

The occurrence of brain metastasis in a patient with low-risk colorectal cancer highlights the need for individualized neurological surveillance strategies in selected patient subgroups, emphasizing the importance of adapting clinical practices based on emerging evidence.