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Chirurgia 2007 February;20(1):19-24

language: English

Impact of combination therapy of neurosurgery and stereotatic radiosurgery for brain metastasis from colorectal cancer. Report of five cases

Itoh H. 1, Nishijima K. 1, Kurosaka Y. 1, Takegawa S. 1, Kiriyama M. 1, Dohba S. 1, Kojima Y. 1, Ikeda K. 2

1 Department of Surgery National Hospital Organization Kanazawa Medical Center, Japan
2 Department of Neurosurgery National Hospital Organization Kanazawa Medical Center, Japan


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Aim. Brain metastasis from colorectal cancer is extremely rare. The present study examined the interval to diagnosis of brain metastasis of colorectal origin, typical neurological symptom, overall survival, and to assess the efficacy of treatment type and metastatic patterns on prognosis.
Methods. A total of 5 patients with metastasis of colorectal cancer to the brain were treated at this hospital between 1983 and 2003. Clinical courses of these patients were retrospectively analyzed. While 4 patients underwent neurosurgery plus Gamma Knife radiosurgery (GKRS), 1 underwent GKRS alone.
Results. Mean patient age was 58 years (range, 51-66 years). Primary tumor location was the colon (n=2) or rectum (n=3). All patients were symptomatic. Median interval between diagnosis of primary cancer and diagnosis of brain metastasis was 18 months. Brain lesions were solitary in 3 patients (60%), and 83% of lesions were supratentorial. Other metastatic lesions were present in 3 patients (60%). Overall median survival was 4.0 months; and 2-year survival rate was 50%. Survival was longer in patients who underwent additional craniotomy than in the patient who underwent GKRS alone. The lung was the most common site of metastasis from colorectal cancer followed by liver. Three patients died of respiratory failure following metastasis to the lungs. Surgical treatment was effective in alleviating neurological symptoms to some extent in all patients.
Conclusion. Combined surgical resection and GKRS of brain metastasis from colorectal cancer appears to both alleviate neurological symptoms and prolong survival.

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