Metastatic brain tumors represent 20% to 40% of all intracranial neoplasms and are found most frequently in association with lung cancer (50%) and breast cancer (12%). Although brain metastases occur in <4% of all tumors of the gastrointestinal (GI) tract, the incidence of GI brain metastasis is rising in part due to more effective systemic treatments and prolonged survival of patients with GI cancer. Data were collected from 25 studies (11 colorectal, 7 esophageal, 2 gastric, 1 pancreatic, 1 intestinal, 3 all-inclusive GI tract cancer) and 13 case reports (4 pancreatic, 4 gallbladder, and 5 small bowel cancer). Brain metastases are found in 1% of colorectal cancer, 1.2% of esophageal cancer, 0.62% of gastric cancer, and 0.33% of pancreatic cancer cases. Surgical resection with whole brain radiation therapy (WBRT) has been associated with the longest median survival (38.4-262 weeks) compared with surgery alone (16.4-70.8 weeks), stereotactic radiosurgery (20-38 weeks), WBRT alone (7.2-16 weeks), or steroids (4-7 weeks). Survival in patients with brain metastasis from GI cancer was found to be diminished compared with metastases arising from the breast, lung, or kidney. Prolonged survival and improvement in clinical symptoms has been found to be best achieved with surgical resection and WBRT. Although early treatment has been linked to prolonged survival and improved quality of life, brain metastases represent a late manifestation of GI cancers and remain an ominous sign. Cancer 2011;117:3630-40. V C 2011 American Cancer Society.KEYWORDS: gastrointestinal cancer, brain metastasis, colorectal cancer, esophageal cancer, gastric cancer, gallbladder cancer, small bowel cancer, pancreatic cancer, whole brain radiation therapy, radiosurgery. 1 An estimated 25% to 35% of cancer cases are complicated by brain metastasis, the development of which is associated with a poor prognosis and an overall median survival of 4.2 months.2 Although brain metastases are frequently diagnosed in patients with lung cancer (48%), breast cancer (15%), testicular cancer (10% to 15%), and malignant melanoma (6% to 10%), 3,4 they rarely arise from gastrointestinal (GI) tract cancers. Bartelt et al 5 reported brain metastases in <4% of malignancies affecting the esophagus, stomach, colon, and rectum. However, the reported incidence of brain metastasis from GI cancers is rising due in part to an increased use of brain imaging modalities in these patients and prolonged survival associated with more effective systemic treatments. 6Gait disturbances, altered mental status or personality changes, and focal neurologic deficits are the most common clinical manifestations of metastatic brain disease, whereas memory loss and seizures are less common. 3,7 Brain metastases are a late manifestation of GI cancer 5 and associated with a median survival of 3.8 months compared with <7 months in similarly affected patients with primary breast or lung cancer. 3This report provides a comprehensive review of the incidence, prevalence, epidemiology, risk factors, ...

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