OBJECTIVE: The goal of this study was to characterize local tumor control (LC), overall survival (OS), and safety of stereotactic radiosurgery for colorectal brain metastasis (CRBM). METHODS: Ten international institutions participating in the International Radiosurgery Research Foundation provided data for this retrospective case series. This study included 187 patients with CRBM (281 tumors), with a median age of 62 years and 56.7% being male. Most patients (53.5%) had solitary tumors, although 10.7% had > 5 tumors. The median tumor volume was 2.7 cm3 (IQR 0.22-8.1 cm3), and the median margin dose was 20 Gy (IQR 18-22 Gy). RESULTS: The 3-year LC and OS rates were 72% and 20%, respectively. Symptomatic adverse radiation effects occurred in 1.6% of patients. In the multivariate analysis, age > 65 years and tumor volume > 4.0 cm3 were significant predictors of tumor progression (hazard ratio [HR] 2.6, 95% CI 1.4-4.9; p = 0.003 and HR 3.4, 95% CI 1.7-6.9; p < 0.001, respectively). Better performance status (Karnofsky Performance Scale score > 80) was associated with a reduced risk of tumor progression (HR 0.38, 95% CI 0.19-0.73; p = 0.004). Patient age > 62 years (HR 1.6, 95% CI 1.1-2.3; p = 0.03) and the presence of active extracranial disease (HR 1.7, 95% CI 1.1-2.4; p = 0.009) were significantly associated with worse OS. CONCLUSIONS: Stereotactic radiosurgery offers a high LC rate and a low rate of symptomatic adverse radiation effects for the majority of CRBMs. The OS and LC favored younger patients with high functional performance scores and inactive extracranial disease.

Ain Shams University Cairo Egypt

Clinical Oncology Ain Shams University Cairo Egypt

Department of Neurological Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania

Department of Neurosurgery Benha University Benha Egypt

Department of Neurosurgery Humanitas Research Hospital IRCCS Milan Italy

Department of Neurosurgery Koc University School of Medicine Istanbul Turkey; and

Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital Taipei Taiwan

Department of Neurosurgery Université de Sherbrooke Quebec Canada

Department of Neurosurgery University of Alberta Edmonton Alberta Canada

Department of Neurosurgery University of Pennsylvania Philadelphia Pennsylvania

Department of Neurosurgery Yale University School of Medicine New Haven Connecticut

Department of Radiation Oncology Mayo Clinic Florida Jacksonville Florida

Department of Radiation Oncology National Cancer Institute Cairo University Cairo Egypt

Department of Radiation Oncology Virginia Commonwealth University Health System Richmond Virginia

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic

Departments of11Neurosurgery and

Departments of22Neurological Surgery and

Departments of5Radiation Oncology and

Departments of7Neurosurgery and

Gamma Knife Center Jewish Hospital Mayfield Clinic Cincinnati Ohio

Gamma Knife Center Nasser Institute Hospital Cairo Egypt

National Yang Ming Chiao Tung University School of Medicine Hsinchu Taiwan

Neurosurgery The James Cancer Hospital and Solove Research Institute Ohio State University Wexner Medical Center Columbus Ohio

Radiation Oncology Allegheny Health Network Pittsburgh Pennsylvania

Radiation Oncology University of Virginia Charlottesville Virginia

Rose Ella Burkhart Brain Tumor and Neuro Oncology Center Neurological Institute Cleveland Clinic Cleveland Ohio

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