Anita Sultan, Hawa Edriss and Nattamol Hosiriluck
Brain metastases are very uncommon in colorectal carcinoma. Only 2-3% of patients at time of diagnosis will have CNS involvement, and only 10% will develop brain lesions during the course of the disease. Patients with rectal carcinoma have brain involvement slightly more frequently than patients with colonic carcinoma; these metastasis are usually found concurrently with lung and/or liver metastasis. Factors associated with longer survival include age less than 65, a single CNS lesion, and the absence of bone metastasis or systemic disease. Our case demonstrates CNS involvement in a patient with known stage III adenocarcinoma of the rectum who presented with syncope and was found to have a brain mass on computed tomography (CT). Surgical management offers prolonged survival in brain metastasis of colorectal cancer. But tumor recurrence following surgery has been as high as 46%. Whole-brain radiotherapy (WBRT) improves outcome and remains the standard therapy. However, delivering this treatment over two weeks period can delay other therapy and is associated with acute and long-term toxicities. Stereotactic radiosurgery is associated with tumor control rates of 73-94% and less morbidity than WBRT. Brachytherapy, intraoperative application of (125I), has high response and control rates, a shorter treatment courses, and minimal toxicity.
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