Clinical outcome with gamma-knife surgery or surgery for brain metastases from colorectal cancer

The aim of this study was to investigate the clinical outcomes after gamma knife surgery (GKS) or surgery as the first treatment for brain metastases in colorectal cancer (CRC). Of the 4350 patients diagnosed with CRC at our institution identified from 1987 to 2009, 27 patients who underwent GKS (GKS group) and 11 who underwent surgery (surgery group) were included. The oncologic outcomes were compared between the two groups. Local control was significantly better in the surgery group than in the GKS group (90% versus [vs.] 71.4%, respectively; p = 0.006). The rate of symptom relief after 3 months was significantly higher in the surgery group than in the GKS group (72.7 vs.18.5%, respectively; p = 0.005). The median survival after GKS was 5.6 months and surgery was 16.2 months. In multivariate analysis, controlled primary tumor (p = 0.038) and solitary metastasis (p = 0.028) were correlated with prolonged overall survival, whereas surgery (p = 0.034) was associated with longer local control. Surgery for brain metastasis from CRC is more advantageous in local control and neurologic symptom palliation than GSK. In multivariate analysis, overall survival was associated with controlled primary tumor and solitary metastasis.