Stereotactic radiosurgery for brain metastases from colorectal cancer

Schoeggl, Andreas; Kitz, K.; Reddy, Marion; Zauner, Christian

doi:10.1007/s00384-001-0362-7

Cited by 45 publications

(37 citation statements)

References 32 publications

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“…The median survival for all 49 patients was 5.1 months (range, 1-18 months), which is consistent with previous reports of patients with BM from CRC in which the median survival ranged from 2.8 months to 6 months. 11,17,21,22,27,28 Analysis of numerous prognostic factors in the current study identified age <65 years, shorter interval from CRC diagnosis to BM diagnosis, and >3 metastases as positive prognostic factors when they were considered as individual variables. However, 8 patients had >3 metastases, which limited our ability to reach a firm conclusion.…”

Section: Discussionmentioning

confidence: 82%

“…Two recent reports have retrospectively assessed the efficacy of SRS on BM from CRC. Schoeggl et al 22 reported the outcomes of 35 patients with CRC who underwent SRS for their BM; 13 of those 35 patients also received WBRT. They demonstrated a local control rate of 94%.…”

Section: Discussionmentioning

confidence: 99%

“…Although previous studies 17,19 reported large cohorts of patients with BM from CRC, those reports analyzed patients who were treated before the incorporation of SRS for BM. Furthermore, in recent studies of SRS for BM from CRC, 21,22 selected patients were deemed appropriate to receive SRS only. To our knowledge, this is the first large, unselected group of patients with BM from CRC reported since the use of SRS has become commonplace.…”

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confidence: 99%

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Multidisciplinary management of colorectal brain metastases

Kruser

Chao

Elson

et al. 2008

Cancer

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BACKGROUND.The incidence of brain metastases (BM) from colorectal cancer (CRC) is increasing, and the management of this previously rare complication at a single institution is reported.METHODS.The records of all patients with BM from 1994 to 2005 were reviewed, and 49 patients (33 men, 16 women) with 102 BM from CRC were identified. Associations between patient and tumor characteristics, treatment modality, and survival were assessed.RESULTS.The median age at diagnosis of BM from CRC was 66 years. Forty patients (82%) had other systemic disease. The median survival after a diagnosis of BM from CRC was 5.1 months. Fifteen patients (31%) underwent surgery at some point, 14 patients (29%) underwent stereotactic radiosurgery (SRS), and 42 patients (86%) received whole‐brain radiotherapy during their management. Seven patients (14%) underwent upfront SRS. On multivariate analysis, a longer interval from diagnosis of CRC to diagnosis of BM was associated significantly with shorter survival (p = .01). Sex, Karnofsky performance status, tumor location, recursive partitioning analysis class, and initial treatment modality did not have an impact on survival.CONCLUSIONS.Because BM from CRC are a late‐stage phenomenon, the majority of patients in the current study had other systemic involvement, and survival after CNS involvement was poor. The results indicated that a high prevalence of systemic disease limits the proportion of patients who are strong candidates for upfront SRS, thereby limiting the impact that this modality has on outcomes in this population as a whole. Late development (>1 year after the primary tumor diagnosis) of CNS involvement may predict for poorer survival after therapy for patients with BM from CRC. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Multidisciplinary management of colorectal brain metastases

Kruser

Chao

Elson

et al. 2008

Cancer

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“…However, increased survival and improvement in clinical symptoms allowing greater functional dependence is achievable with both SR and SRS in select patients. 3,6,45,[58][59][60] It is important to emphasize, however, that patients who are considered for neurosurgical intervention are those who demonstrate good prognostic factors, and this selection bias may be responsible for the apparent success of surgical intervention in prolonging survival. Although the addition of WBRT does not significantly enhance postoperative survival following SR or SRS, it may reduce the likelihood of recurrence, increase the time to recurrence, and minimize the chance of death from neurologic complications.…”

Section: Discussionmentioning

confidence: 99%

“…70) who cannot tolerate surgery and have brain lesions <3.5 cm in diameter. 6,58,59 Although early treatment is linked to prolonged survival and improved quality of life, brain metastasis represents an advanced manifestation of GI cancer that is uniformly fatal.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal cancer and brain metastasis

Klaassen

Meadows

et al. 2011

Cancer

168

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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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Gamma Knife for Cerebral Metastases

Ganz¹

2010

Gamma Knife Neurosurgery

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Stereotactic radiosurgery for brain metastases from colorectal cancer

Abstract: SR for brain metastases from colorectal cancer results in a high local tumor control rate of 94% associated with few complications and therefore provides patients with a higher quality of their remaining life.

Cited by 45 publications

References 32 publications

Multidisciplinary management of colorectal brain metastases

Multidisciplinary management of colorectal brain metastases

Gastrointestinal cancer and brain metastasis

Gamma Knife for Cerebral Metastases

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