• Othman Bin-Alamer, Hussam Abou-Al-Shaar, Raj Singh, Arka N Mallela, Andrew Legarreta, Greg Bowden, David Mathieu, Haley K Perlow, Joshua D Palmer, Shahed Elhamdani, Matthew Shepard, Yun Liang, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, Khaled Abdelkarim, El-ShehabyAmr M NAMN9Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt.Departments of11Neurosurgery and., Reem Emad Eldin, Ahmed Hesham Elazzazi, Ronald E Warnick, Yair M Gozal, Megan Daly, Brendan McShane, Marcel Addis-Jackson, Gokul Karthikeyan, Sian Smith, Piero Picozzi, Andrea Franzini, Tehila Kaisman-Elbaz, Huai-Che Yang, Judith Hess, Kelsey Templeton, Xiaoran Zhang, Zhishuo Wei, Stylianos Pikis, Georgios Mantziaris, Gabriela Simonova, Roman Liscak, Selcuk Peker, Yavuz Samanci, Veronica Chiang, Charles R Kersh, Cheng-Chia Lee, Daniel M Trifiletti, Ajay Niranjan, Constantinos G Hadjipanayis, L Dade Lunsford, and Jason P Sheehan.
• 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
• J. Neurosurg. 2024 May 1; 140 (5): 123312421233-1242.

ObjectiveThe goal of this study was to characterize local tumor control (LC), overall survival (OS), and safety of stereotactic radiosurgery for colorectal brain metastasis (CRBM).MethodsTen 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).ResultsThe 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.ConclusionsStereotactic 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.

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