title: Multidisciplinary management of colorectal brain metastases: a retrospective study.
abstract: BACKGROUND
  The incidence of brain metastases (BM) from colorectal cancer (CRC) is increasing, and the management of this previously rare complication at a single institution is reported.
  
  
  METHODS
  The records of all patients with BM from 1994 to 2005 were reviewed, and 49 patients (33 men, 16 women) with 102 BM from CRC were identified. Associations between patient and tumor characteristics, treatment modality, and survival were assessed.
  
  
  RESULTS
  The median age at diagnosis of BM from CRC was 66 years. Forty patients (82%) had other systemic disease. The median survival after a diagnosis of BM from CRC was 5.1 months. Fifteen patients (31%) underwent surgery at some point, 14 patients (29%) underwent stereotactic radiosurgery (SRS), and 42 patients (86%) received whole-brain radiotherapy during their management. Seven patients (14%) underwent upfront SRS. On multivariate analysis, a longer interval from diagnosis of CRC to diagnosis of BM was associated significantly with shorter survival (p = .01). Sex, Karnofsky performance status, tumor location, recursive partitioning analysis class, and initial treatment modality did not have an impact on survival.
  
  
  CONCLUSIONS
  Because BM from CRC are a late-stage phenomenon, the majority of patients in the current study had other systemic involvement, and survival after CNS involvement was poor. The results indicated that a high prevalence of systemic disease limits the proportion of patients who are strong candidates for upfront SRS, thereby limiting the impact that this modality has on outcomes in this population as a whole. Late development (>1 year after the primary tumor diagnosis) of CNS involvement may predict for poorer survival after therapy for patients with BM from CRC.
authors.affiliation: Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Kruser
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Chao
authors.forename: Paul
authors.initials: P
authors.lastname: Elson
authors.forename: Gene H
authors.initials: GH
authors.lastname: Barnett
authors.forename: Michael A
authors.initials: MA
authors.lastname: Vogelbaum
authors.forename: Lilyana
authors.initials: L
authors.lastname: Angelov
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil
authors.forename: Robert
authors.initials: R
authors.lastname: Pelley
authors.forename: John H
authors.initials: JH
authors.lastname: Suh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016634:Radiosurgery; D012189:Retrospective Studies