Brain metastases from colorectal cancer [Zerebrale metastasen bei kolorektalen karzinomen]

Background: Patients with brain metastases from colorectal cancer are supposed to have the lowest median survival compared to other locations of metastases from this cancer. Patients with brain metastases usually receive highly palliative treatment and are excluded from studies investigating new therapeutic concepts. However, there appears to be a subgroup of patients with brain metastases originating from colorectal cancer who have a median survival comparable to that of other metastatic sites. Patients and Methods: Between November 1996 and October 2000, 13 out of 113 patients from our clinic with colorectal cancer had brain metastases (11.5%). We describe their heterogeneous clinical course and present a review of the literature. Results: The median survival time after the diagnosis of brain metastases was 9.0 months for all patients, less than 1 month for three patients who received only supportive care, 40 months for a patient who was treated with radiosurgical resection, 3 months for two patients who received whole brain radiation, and 10.4 months for seven patients who underwent surgical resection. The median interval between the diagnosis of primary cancer and the diagnosis of brain metastases was 26.5 months (2-84). In one case brain metastasis was the initial manifestation of colorectal cancer. Five patients are still alive with a survival time between 6-40 months. Conclusion: The clinical course of our 13 patients varied significantly. Thus, patients with brain metastases of colorectal cancer may profit from modern multimodal therapeutic concepts. A therapeutic nihilism should be avoided.