gms | German Medical Science

Objective: Colorectal carcinoma (CRC) is often describes as a rare cause for brain metastases (BM). Few studies focus on the neurosurgical therapy. BM tend to occur late in the course of CRC and surgical removal in general is performed in a minority of patients. In this retrospective analysis, patients with surgically treated BM caused by CRC were followed up in terms of clinical outcome, morbidity, and survival.

Methods: A retrospective analysis of 608 patients with BM of different primary tumours having tumor resection at the Department of Neurosurgery, Saarland University Medical Center, between 01/2007 and 03/2016 was conducted. Clinical and patient-related data as well as histopathological, radiological and neurosurgical data were collected from the patients’ records.

Results: Fifty-nine patients (9.7%) had been diagnosed with CRC. Twenty-eight (47.5%) patients were female and 31 (52.5%) patients were male. Mean age was 66.9 years. A singular metastasis was present in 42 (71.2%) patients whereas in 27 (28.8%) patients multiple metastases occurred. Mean follow-up time was 179.4 days (5.6 months). Tumor resection was performed in all patients without having special primary exclusion criteria such as advanced age, poor general condition, extracranial tumour activity, neurological symptoms or number and size of tumors. Supratentorial metastases occurred in 37 patients (67.7%), and infratentorial metastases occurred in 19 (32.2%) patients. In 6 (10.2%) patients, combined supra- and infratentorial metastases were present. Mean overall survival of the present cohort was 138.4 days (4.6 months) and up to 36 months. Mean survival of patients with posterior fossa BM was 6.1 months compared to patients with supratentorial BM (4.2 months). If case of supra- and infratentorial BM, the outcome was poor with a mean survival of 6 weeks.

Conclusion: BM developing from CRC were diagnosed frequently and were treated with surgical removal without general preclusion of certain factors such as old age. Surgical resection seemed to have a positive impact in many patients. Overall survival of patients with infratentorial BM was best despite the prevailing opinion in the literature of a less favourable prognosis due to posterior fossa metastases. Surgical removal might be beneficial at an advanced tumor stage of CRC disease as well. In many patients, surgical tumor resection is crucial to preserve quality of life. A more generous indication should be considered in many patients suffering from CRC brain metastases.