Journal of Cancer Research and Clinical Oncology

, 135:451

Neurosurgical management and postoperative whole-brain radiotherapy for colorectal cancer patients with symptomatic brain metastases

Authors

    • University Hospital of Udine
  • Elisa Zanon
    • University Hospital of Udine
  • Francesco Tuniz
    • University Hospital of Udine
  • Emiliana Iaiza
    • University Hospital of Udine
  • Federica De Pauli
    • University Hospital of Udine
  • Nicoletta Pella
    • University Hospital of Udine
  • Stefano Pizzolitto
    • University Hospital of Udine
  • Alberto Buffoli
    • University Hospital of Udine
  • Andrea Piga
    • University Hospital of Udine
  • Miran Skrap
    • University Hospital of Udine
  • Gianpiero Fasola
    • University Hospital of Udine
Original Paper

DOI: 10.1007/s00432-008-0468-1

Cite this article as:
Aprile, G., Zanon, E., Tuniz, F. et al. J Cancer Res Clin Oncol (2009) 135: 451. doi:10.1007/s00432-008-0468-1

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.

Keywords

Colorectal cancerBrain metastasesRadiotherapyNeurosurgery

Copyright information

© Springer-Verlag 2008