BRAIN METASTASES FROM COLORECTAL-CARCINOMA - THE LONG-TERM SURVIVORS

BACKGROUND. Brain metastases occur in 25% to 35% of all cancer patient s, with colorectal carcinoma accounting for approximately 8% of these. Information about patients with brain metastases from colorectal carc inoma is limited, with the largest previous series reporting only 40 p atients. To date there have been no reports describing the subgroup of patients with long term survival (> 1 yr). METHODS. A retrospective r eview of 150 patients seen at the Mayo Clinic between 1976 and 1993 wi th pathologic (56) and/or radiographic (94) confirmation of brain meta stases from colorectal carcinoma is presented. RESULTS. The majority o f patients (82%) with brain metastases from colorectal carcinoma have concomitant extracerebral metastases, especially in the lungs. Only 16 % of the patients survived > 1 year after diagnosis (4 > 4 yrs., 2 > 1 0 yrs). Of these, 92% had single cerebral metastases and 38% had no sy stemic metastases. In addition, young age and the absence of bony meta stases or memory loss were associated with increased survival. Median survival for all of the patients receiving surgery and radiotherapy (3 9), surgery alone (11), radiotherapy alone (79) and supportive care (1 7) are 42, 45, 16, and 8 weeks, respectively. Thirty percent of the pa tients treated with radiotherapy showed regression of their tumors on followup head scans; three had complete regression. CONCLUSIONS. One-y ear survivors of brain metastases from colorectal carcinoma were uncom mon, accounting for 16% of the patients and most of these (92%) bad so litary lesions. Nineteen of 24 long term survivors had surgical resect ion as part of their treatment. Given the similar results in patients treated with surgery plus radiotherapy and those treated with surgery alone, as well as the potential long term side effects of radiotherapy , withholding radiotherapy for those patients with the possibility of long term survival should be considered. (C) 1996 American Cancer Soci ety.