Gamma Knife Radiosurgery for Metastatic Brain Tumors from Colorectal Cancer

In-Young Kim1, Shin Jung2, Tae-Young Jung2, Woo-Youl Jang2, Kyung-Sub Moon2, Seung-Jin Park2

1 2Brain Tumor Clinic & Gamma knife Center, Department of Neurosurgery, Chonnam Nat

Keywords: brain metastasis, radiosurgery, gamma knife, outcome, brain tumor

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     Brain metastases from colorectal cancer are rare, but the prognosis is known to be poor for colorectal cancer patients with brain metastases. 
     We managed the patients mainly with gamma knife radiosurgery (GKR), and investigated the local control and the patients’ survival.
     Between September 2004 and May 2011, total 23 patients underwent GKR for metastatic brain tumor(s) from colorectal cancer. The mean age was 68.2 years (range, 50 to 86). Most of the patients were RPA class II (91%) and had other organ metastasis (91%). The locations of the tumors were supratentorial location (n=50), and cerebellum (n=19).
      At GKR, the mean tumor volume was 2.66 cc and the median prescription dose was 20 Gy (range, 12 to 24) to the tumor margin. We reviewed all clinical and imaging results.
     The clinical and imaging follow-up was done in 15 patients with 45 tumors. The tumor control rate was 78% (35 out of 45 tumors), and the median progression-free survival was 6.8 months. The significant favorable prognostic factors related to the tumor control were prescription radiation dose more than 18 Gy (p=0.001), but tumor volume less than 5cc was not (p= 0.145). The locally recurred tumors were managed with repeated GKR (n=4) and simple palliation (n=3). Newly developed metastases were detected in 11 patients (73%), and they were managed with second GKR (n=5), second & 3rd GKR (n=1), second GKR & radiation therapy (n=1), and simple palliation (n=4). In all 23 patients, overall median survival after the GKR was 4.9 months, and 5 patients (21.7%) are still alive. The patient’s age (age > 65) showed longer survival (9.3 months, p=0.453). The statistically significant prognostic factors related to overall survival were single metastasis (p= 0.006) and tumor number not more than 5 (p= 0.008). Main cause of death was the systemic problem, and no mainly brain-related death patient was detected.
     This was a retrospective series.
     GKR could be the one of the best management options for the metastatic tumors from the colorectal cancer.
     Considering the reported relatively short survival after cerebral metastasis in this disease, GKR could be another palliative treatment.


Project Roles:

I. Kim (), S. Jung (), T. Jung (), W. Jang (), K. Moon (), S. Park ()