Colorectal carcinoma and brain metastasis: Distribution, treatment, and survival Authors
Received: 26 June 1995 Accepted: 04 December 1995 DOI:
Cite this article as: Hammound, M.A., McCutcheon, I.E., Elsouki, R. et al. Annals of Surgical Oncology (1996) 3: 453. doi:10.1007/BF02305763
Background: Brain metastasis from colorectal cancer is rare. The present study reports the nature of this disease and analyzes factors correlated with survival in patients harboring such disease.
Patients and Methods: One hundred patients diagnosed between 1980 and 1994 with metastatic brain tumors secondary to colorectal adenocarcinoma were retrospectively reviewed. Of these patients, 36 underwent surgery, 57 underwent radiotherapy alone, and the remaining seven received steroids.
Results: The most common primary sites were the sigmoid colon and rectum (65%). Brain metastases with concomitant liver and/or lung metastases were seen more frequently than brain metastases alone. The median interval between the diagnosis of primary cancer and the diagnosis of brain metastasis was 26 months (95% confidence interval =22–30). The median survival time after the diagnosis of brain metastasis was 1 month for patients who received only steroids, 3 months for those who received radiotherapy (p=0.1), and 9 months for those who underwent surgery (p<0.0001). The extent of noncerebral systemic disease was not correlated with survival (p>0.05), but early onset of brain metastasis was significantly associated with poor prognosis (p=0.04).
Conclusion: Surgical removal of colorectal metastatic brain lesions results in significantly increased survival time, regardless of the status of the noncerebral systemic disease.
Aronson SM, Garcia JH, Aronson BE. Metastatic neoplasms of the brain: their frequency in relation to age.
Takakura K, Sano K, Hojo S, Hirano A.
Metastatic tumors of the central nervous system. Tokyo: Igaku-Shoin, 1982.
Wright DC, Delaney TF, Buckner JC. Treatment of metastatic cancer to the brain. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.
Principles and practice of oncology. 4th ed. Philadelphia: JB Lippincott, 1993:2170–86.
Winston KR, Walsh JW, Fischer EG. Results of operative treatment of intracranial metastatic tumors.
Cairncross JG, Kim J-H, Posner JB. Radiation therapy for brain metastases.
Weiss L, Grundmann E, Torhorst J, et al. Hematogenous metastatic patterns in colonic carcinoma: an analysis of 1541 necropsies.
Floyd CE, Stirling CT, Cohn I Jr. Cancer of the colon, rectum and anus: review of 1,687 cases.
Posner JB. Brain metastases: a clinician's view. In: Weiss L, Gilbert HA, Posner JB, eds.
Brain metastases. Boston: GK Hall, 1980:2–29.
Moertel CG. Accomplishments in surgical adjuvant therapy for large bowel cancer.
Galicich JH, Sundaresan N, Arbit E, Passe S. Surgical treatment of single brain metastasis: factors associated with survival.
Sundaresan N, Galicich JH. Surgical treatment of brain metastases. Clinical and computerized tomography evaluation of the results of treatment.
Sato H, Tsuchiya A, Nomizu T, et al. The neurosurgical management of brain metastasis from colorectal cancer.
Cascino TL, Leavengood JM, Kemeny N, Posner JB. Brain metastasis from colon cancer.
Chyun Y, Hayward E, Lokich J. Metastasis to the central nervous system from colorectal cancer.
Med Pediatr Oncol
Rovirosa R, Bodi R, Vincente P, Lastuey I, Giralt J, Salvador L. Metastasis cerebrales en el adenocarcinoma de colon.
Rev Esp Enferm Dig
Sriram I, Banmann MA. Multiple isolated brain metastases from a Dukes' B colon carcinoma.
Irish J Med Sci
Ruelle A. Brain metastasis from colon cancer. Case report showing a clinical and CT unusual appearance.
J Neurosurg Sci
Karnofsky DA, Barachend LJH, Armstead GD, et al. Triethyline melanine in the treatment of neoplastic disease.
Arch Intern Med 1951;87:477–516.
Cox DR. Regression models and life tables.
J R Stat Soc 1972;B34:187–220.
Kaplan EL, Meier P. Non-parametric estimation from incomplete observation.
J Am Stat Assoc 1958;53:457–81.
Wingo PA, Tong T, Bolden S. Cancer statistics, 1995.
Olson RM, Perencevich NP, Malcolm AW, Chattey JT, Wilson RE. Patterns of recurrence following curative resection of adenocarcinoma of the colon and rectum.
Dawson LE, Russell AH, Tong D, Wisbeck WM. Adenocarcinoma of the sigmoid colon: sites of initial dissemination and clinical patterns of recurrence following surgery alone.
J Surg Oncol
Minsky BD, Mies C, Rich TA, Recht A, Chaffey JT. Potentially curative surgery of colon cancer: patterns of failure and survival.
J Clin Oncol
Pilipshen SJ, Heilweil M, Quan SHQ, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer.
Foster JH. Survival after liver resection for secondary tumors.
Am J Surg
Patanaphan V, Salazar OM. Colorectal cancer: metastatic patterns and prognosis.
South Med J
Williams PL, Warwick R.
Gray's anatomy. 36th ed. Edinburgh, Scotland: Churchill Livingstone, 1980.
Amer MH, Al-Sarraf M, Baker LH, Vaitkevicius VK. Malignant melanoma and central nervous system metastases. Incidence, diagnosis, treatment and survival.
Chason JL, Walker FB, Landers JW. Metastatic carcinoma in the central nervous system and dorsal root ganglia. A prospective autopsy study.
Delattre JY, Krol G, Thaler HT, Posner JB. Distribution of brain metastases.
Davis PC, Hudgins PA, Peterman SB, Hoffman JC Jr. Diagnosis of cerebral metastases: double-dose delayed CT vs contrast-enhanced MR imaging.
Am J Neuroradiol
Sze G, Milano E, Johnson C, Heier L. Detection of brain metastases: comparison of contrast-enhanced MR with unenhanced MR and enhanced CT.
Am J Neuroradiol
Ask-Upmark E. Metastatic tumors of the brain and their localization.
Acta Med Scand
Graf AH, Buckberger W, Langmayr H, Schmid KW. Site preference of metastatic tumours of the brain.
Virchows Arch [A] 1988;412:493–8.
Lang EF, Slater J. Metastatic brain tumors: results of surgical and nonsurgical treatment.
Surg Clin North Am
Vaneck JHM, Go KG, Ebels EJ. Metastatic tumors of the brain.
Psychiatr Neurol Neurochir 1965;68:443–62.
Markesbery WR, Brooks WH, Gupta GD, Young AB. Treatment for patients with cerebral metastases.
Ruderman NB, Hall TC. Use of glucocorticoids in the palliative treatment of metastatic brain tumors.
Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain.
N Engl J Med
Kuratsu J, Matsukado Y, Nonaka N, et al. Computed tomography in brain metastasis of colorectal cancer [in Japanese].
CT Kenkyuu 1984;6:543–7.
Yoshikawa N, Sasai T, Shimase K, et al. The study of brain metastasis from colorectal cancer [in Japanese].
Geka Shinryou 1981;23:61–4.
Wakisaka S, Kureya A, Miyahara K, et al. Clinical study of metastatic brain tumors from carcinomas of the digestive organs [in Japanese].
Gan No Rinsho 1989;35:1654–49.
Galicich JH, Arbit E. Metastatic brain tumors. In: Youman JR, ed.
Neurological surgery. 3rd ed. Philadelphia: WB Saunders, 1990:3204–22. Copyright information
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