title: Neurosurgical management and postoperative whole-brain radiotherapy for colorectal cancer patients with symptomatic brain metastases.
abstract: BACKGROUND
  New systemic treatments for advanced colorectal cancer have conferred a survival advantage, allowing patients to reach a median survival of almost 2 years. Due to this remarkable life extension, the incidence of brain metastases, though still low, is progressively increasing over time. There is little reported data on the optimal strategy to manage brain lesions from colorectal cancer.
  
  
  METHODS
  To explore the role of an aggressive approach to colorectal cancer brain metastases, we retrospectively collected and analyzed data from 30 patients who underwent neurosurgical resection + whole-brain radiotherapy between March 1998 and December 2006. Univariate (logrank) and multivariate (Cox's model) analyses were used to identify prognostic factors.
  
  
  RESULTS
  Median age at the time of surgery was 66 years, median ECOG PS was 1, most patients (87%) had concomitant lung and/or liver metastases. Median number of previous chemotherapies was two, with half of the patients being exposed both to oxaliplatin and irinotecan. A median of 27 Gy of radiotherapy were administered to 16 patients after resection. At the time of the analysis, 29 out of 30 patients had died, with a median survival time after brain metastasectomy of 167 days (8-682). Only one patient died within a month from surgery. Median survival was significantly longer in patients who received postsurgical radiotherapy (7.6 vs. 4.7 months, P = 0.014).
  
  
  CONCLUSIONS
  Neurosurgical management of symptomatic brain metastases from colorectal cancer is feasible, relatively safe, and offers a chance of prolonged survival. Patients who received radiotherapy after resection experienced a better outcome.
authors.affiliation: University Hospital of Udine, Udine, Italy. aprile.giuseppe@aoud.sanita.fvg.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aprile
authors.forename: Elisa
authors.initials: E
authors.lastname: Zanon
authors.forename: Francesco
authors.initials: F
authors.lastname: Tuniz
authors.forename: Emiliana
authors.initials: E
authors.lastname: Iaiza
authors.forename: Federica
authors.initials: F
authors.lastname: De Pauli
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Pella
authors.forename: Stefano
authors.initials: S
authors.lastname: Pizzolitto
authors.forename: Alberto
authors.initials: A
authors.lastname: Buffoli
authors.forename: Andrea
authors.initials: A
authors.lastname: Piga
authors.forename: Miran
authors.initials: M
authors.lastname: Skrap
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Fasola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology*; D004210:Dissection / Q000379:methods; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology / Q000532:radiotherapy*; D019635:Neurosurgical Procedures; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
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