Neurosurgical management and postoperative whole-brain radiotherapy for colorectal cancer patients with symptomatic brain metastases.
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.
Aprile
Giuseppe
G
University Hospital of Udine, Udine, Italy. aprile.giuseppe@aoud.sanita.fvg.it
Zanon
Elisa
E
Tuniz
Francesco
F
Iaiza
Emiliana
E
De Pauli
Federica
F
Pella
Nicoletta
N
Pizzolitto
Stefano
S
Buffoli
Alberto
A
Piga
Andrea
A
Skrap
Miran
M
Fasola
Gianpiero
G
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
J Clin Oncol. 1996 Jul;14(7):2047-53
8683235
J Clin Oncol. 2005 Jul 10;23(20):4553-60
16002847
N Engl J Med. 2004 Jun 3;350(23):2335-42
15175435
J Clin Oncol. 2007 Apr 20;25(12):1539-44
17442997
J Neurooncol. 1983;1(3):203-9
6678969
J Clin Pathol. 2005 Mar;58(3):237-42
15735152
Oncologist. 2007 Jul;12(7):884-98
17673619
J Clin Oncol. 2007 May 1;25(13):1658-64
17470858
JAMA. 2006 Nov 1;296(17):2089-90; author reply 2090-1
17077371
Cancer. 2003 Nov 1;98(9):1925-33
14584076
Eur J Neurol. 2006 Jul;13(7):674-81
16834697
JAMA. 1998 Nov 4;280(17):1485-9
9809728
Curr Opin Oncol. 2005 Nov;17(6):588-92
16224238
J Clin Oncol. 2005 Dec 20;23(36):9441-2
16361649
Cancer. 1995 Sep 1;76(5):765-73
8625178
J Pathol. 1986 Nov;150(3):195-203
3806280
N Engl J Med. 2007 Nov 15;357(20):2040-8
18003960
Curr Oncol. 2007 Aug;14(4):131-43
17710205
Gut. 2006 Aug;55 Suppl 3:iii1-8
16835351
Cancer. 1999 Apr 15;85(8):1677-85
10223560
Ann Surg Oncol. 1999 Dec;6(8):771-6
10622506
Ann Surg. 2004 Oct;240(4):644-57; discussion 657-8
15383792
Ann Thorac Surg. 2007 Jul;84(1):324-38
17588454
Ann Surg Oncol. 1996 Sep;3(5):453-63
8876887
Int J Radiat Oncol Biol Phys. 2000 Jul 1;47(4):1001-6
10863071
Cancer. 2008 Jul 1;113(1):158-65
18459179
Int J Colorectal Dis. 2005 Jan;20(1):57-61
15309466
N Engl J Med. 2004 Jul 22;351(4):337-45
15269313
Int J Radiat Oncol Biol Phys. 1994 Jul 1;29(4):711-7
8040016
Lancet Neurol. 2005 May;4(5):289-98
15847842
CA Cancer J Clin. 2007 Jan-Feb;57(1):43-66
17237035
Tumori. 2005 Mar-Apr;91(2):163-7
15948545