Brain metastases from colorectal cancer

PURPOSE: We wished to determine the time interval before diagnosis of brain metastases from a colorectal origin, typical neurologic presentation, overall survival, and impact of type of treatment and metastatic growth patterns (solitary, location, etc.) on prognosis. METHODS: Between 1980 and 1994 we retrospectively identified 19 patients with metastatic colorectal cancer to the brain. Data were collected with regard to patient characteristics, location and stage of primary tumor, and extent and location of metastatic disease. Statistical analyses were performed with STATISTICA(TM) for Windows(TM). RESULTS: Mean patient age was 66 (43-87) years. Primary tumor location was distributed throughout the colon; 58 percent had disseminated disease when first diagnosed. All patients were symptomatic. Lesions were solitary in 63 percent, unilateral in 89 percent, and cerebral in 53 percent. Overall median survival was 2.8 months; 1-year survival was 0 percent. Survival was longer following craniotomy (4.1 months) compared with radiation (2.8 months); however, survival was not affected by number or location of metastatic lesions or whether the brain was the sole site of metastatic disease. CONCLUSIONS: Brain metastases from colorectal cancer are infrequently the sole site of metastatic disease, and because survival is dismal regardless of form of therapy chosen, craniotomy is rarely indicated. Exception is the rare patient who has minimum neurologic impairment, a long disease-free interval, a solitary metastasis, and no extracranial disease.