Colorectal cancer intracranial metastases treatment [Neurosurgery Wiki]

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====== Colorectal cancer intracranial metastases treatment ======

see also [[Intracranial metastases treatment]].
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Current treatment options for brain metastases from CRC include surgical resection, whole-brain radiotherapy ([[WBRT]]), [[stereotactic radiotherapy]] (SRT), which includes [[stereotactic radiosurgery]] and [[fractionated stereotactic radiotherapy]], and [[chemotherapy]], alone or in combination. In general, surgical resection is performed for a single large (typically > 3 cm) brain metastasis with massive edema or when the metastasis is located in the eloquent area. Stereotactic radiosurgery using the [[Gamma Knife]]® or [[CyberKnife]]® is usually indicated for oligometastases of small sizes up to 3 cm. In fractionated stereotactic radiotherapy, which is typically performed for larger-sized brain metastases that cannot be handled by stereotactic radiosurgery, patients are treated with the CyberKnife® using a prescribed dose of 27–35 Gy delivered in 3–5 fractions in the tumor periphery. WBRT is selected for patients with multiple metastases or large-sized oligometastases with uncontrolled extracranial metastases, and/or those with poor performance status. Typical WBRT consists of 30 Gy in 10 fractions to the isocenter, delivered five times weekly with a linear accelerator
((Imaizumi J, Shida D, Narita Y, Miyakita Y, Tanabe T, Takashima A, Boku N,
Igaki H, Itami J, Kanemitsu Y. Prognostic factors of brain metastases from
colorectal cancer. BMC Cancer. 2019 Jul 31;19(1):755. doi:
10.1186/s12885-019-5973-x. PubMed PMID: 31366387; PubMed Central PMCID:
PMC6670227.
)).
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The start of chemotherapy treatment usually requires a delay of about 4 weeks after surgical resection in patients with primary CRC having synchronous distant metastasis. However, there is no evidence to indicate the required length of this delay interval. In addition, there is a chance that a patient may die because postoperative chemotherapy was not started soon enough and a metastatic tumor was able to develop rapidly ((Yoshida Y, Hoshino S, Miyake T, Fukuda S, Yamada K, Naoya A, Tanimura S,
Yamashita Y. Early start of chemotherapy after resection of brain metastasis from
colon cancer with synchronous multiple liver metastases. Case Rep Oncol. 2012
May;5(2):290-5. doi: 10.1159/000339614. Epub 2012 Jun 5. PubMed PMID: 22740818;
PubMed Central PMCID: PMC3383236.)).