Aprile Giuseppe, Zanon Elisa, Tuniz Francesco, Iaiza Emiliana, De Pauli Federica, Pella Nicoletta, Pizzolitto Stefano, Buffoli Alberto, Piga Andrea, Skrap Miran, Fasola Gianpiero
University Hospital of Udine, Udine, Italy.
J Cancer Res Clin Oncol. 2009 Mar;135(3):451-7. doi: 10.1007/s00432-008-0468-1. Epub 2008 Sep 9.
New systemic treatments for advanced colorectal cancer have conferred a survival advantage, allowing patients to reach a median survival of almost 2 years. Due to this remarkable life extension, the incidence of brain metastases, though still low, is progressively increasing over time. There is little reported data on the optimal strategy to manage brain lesions from colorectal cancer.
To explore the role of an aggressive approach to colorectal cancer brain metastases, we retrospectively collected and analyzed data from 30 patients who underwent neurosurgical resection + whole-brain radiotherapy between March 1998 and December 2006. Univariate (logrank) and multivariate (Cox's model) analyses were used to identify prognostic factors.
Median age at the time of surgery was 66 years, median ECOG PS was 1, most patients (87%) had concomitant lung and/or liver metastases. Median number of previous chemotherapies was two, with half of the patients being exposed both to oxaliplatin and irinotecan. A median of 27 Gy of radiotherapy were administered to 16 patients after resection. At the time of the analysis, 29 out of 30 patients had died, with a median survival time after brain metastasectomy of 167 days (8-682). Only one patient died within a month from surgery. Median survival was significantly longer in patients who received postsurgical radiotherapy (7.6 vs. 4.7 months, P = 0.014).
Neurosurgical management of symptomatic brain metastases from colorectal cancer is feasible, relatively safe, and offers a chance of prolonged survival. Patients who received radiotherapy after resection experienced a better outcome.
晚期结直肠癌的新型全身治疗带来了生存优势，使患者的中位生存期接近2年。由于生存期显著延长，脑转移的发生率尽管仍然较低，但随时间推移呈逐渐上升趋势。关于结直肠癌脑转移灶的最佳处理策略，报道的数据较少。
为探讨积极治疗结直肠癌脑转移的作用，我们回顾性收集并分析了1998年3月至2006年12月期间接受神经外科手术切除+全脑放疗的30例患者的数据。采用单因素（对数秩检验）和多因素（Cox模型）分析来确定预后因素。
手术时的中位年龄为66岁，中位东部肿瘤协作组体能状态（ECOG PS）为1，大多数患者（87%）伴有肺和/或肝转移。既往化疗的中位次数为2次，一半的患者同时接受了奥沙利铂和伊立替康治疗。16例患者术后接受了中位剂量为27 Gy的放疗。在分析时，30例患者中有29例死亡，脑转移瘤切除术后的中位生存时间为167天（8 - 682天）。仅1例患者在术后1个月内死亡。接受术后放疗的患者中位生存期明显更长（7.6个月对4.7个月，P = 0.014）。
对结直肠癌有症状的脑转移进行神经外科治疗是可行的，相对安全，并提供了延长生存期的机会。切除术后接受放疗的患者预后更好。
