title: Prognostic factors for patients with advanced colorectal cancer and symptomatic brain metastases.
abstract: BACKGROUND
  Increased rates of long-term survival after CRC diagnosis are accompanied by increases in the incidence of BMs. Here, we retrospectively evaluated the outcomes of patients with BMs from CRC.
  
  
  METHODS
  We reviewed the records of 1364 patients with CRC treated between January 1999 and December 2010 at Kinki University Hospital in Japan. Twenty-five of these patients developed BMs. Log-rank tests and Cox regression analyses were used to assess potential prognostic factors for survival.
  
  
  RESULTS
  Among the patients with BMs, BMs developed a median of 25.3 (range, 11.4-111) months after primary CRC surgery. There was a median of 2 BMs per patient. Eleven patients had solitary BMs. Concomitant extracerebral metastases, particularly lung metastases, were found in 23 patients. Twenty-three patients were receiving systemic chemotherapy at the time of diagnosis with BMs. After the development of BMs, the median survival time (MST) was 2.8 months. The MST was 4.8 months among patients who underwent neurosurgical resection (n = 6) or stereotactic surgery (n = 9, including combined therapy in 2 patients) and 1.5 months among patients who underwent whole-brain radiotherapy only or best supportive care (n = 12). In multivariate analysis, single BMs and additional systemic chemotherapy after BMs diagnosis were significantly associated with overall survival (P = .022 and .023, respectively).
  
  
  CONCLUSIONS
  Our results suggest that advancements in continuing systemic chemotherapy prolong survival among patients with BMs from CRC. Clinicians should be especially aware of BMs in patients with lung metastases.
authors.affiliation: Department of Surgery, Kinki University, Faculty of Medicine, Osaka, Japan. Electronic address: tokoro@surg.med.kindai.ac.jp.
authors.forename: Tadao
authors.initials: T
authors.lastname: Tokoro
authors.affiliation: Department of Surgery, Kinki University, Faculty of Medicine, Osaka, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Okuno
authors.affiliation: Department of Surgery, Kinki University, Faculty of Medicine, Osaka, Japan.
authors.forename: Jin-chi
authors.initials: JC
authors.lastname: Hida
authors.affiliation: Department of Surgery, Kinki University, Faculty of Medicine, Osaka, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Ueda
authors.affiliation: Department of Surgery, Kinki University, Faculty of Medicine, Osaka, Japan.
authors.forename: Takehito
authors.initials: T
authors.lastname: Yoshifuji
authors.affiliation: Department of Surgery, Kinki University, Faculty of Medicine, Osaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Daito
authors.affiliation: Department of Surgery, Kinki University, Faculty of Medicine, Osaka, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Sugiura
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D016634:Radiosurgery; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Intracerebral metastases; Prognosis; Recursive partitioning analysis; Stereotactic surgery; Systemic chemotherapy