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3, 42, 43, 45 Surgery, with or without WBRT, is the optimal initial management for isolated CRC brain metastasis in patients who are good surgical candidates. This combination can yield significant improvement in quality of life and prolong median survival up to 45 weeks.3 Of note, the addition of radiotherapy to surgical resection did not affect overall survival or recurrence rate (surgery alone = 36%; surgery + WBRT = 32%, P http://www.selleck.cn/products/gsk126.html a cohort of 150 patients with CRC brain metastases, Farnell et al3 noted 24 patients who survived >1 year (range, 13-153 months) after diagnosis. Among these 24 long-term survivors, 19 (79%) were treated surgically (16 received adjuvant radiotherapy), 9 (38%) had no additional systemic disease, and 9 (38%) had only pulmonary metastases.3 CRC brain metastases are rare and diagnosed in http://www.selleckchem.com/products/Cyclopamine.html with extracranial metastasis, whereas routine neuroimaging for staging purposes is not beneficial. Brain metastases from gastrointestinal cancers are rare, and their presence represents an ominous prognostic sign. Nonetheless, http://www.selleckchem.com/products/BI-2536.html the incidence is increasing due to earlier diagnosis and prolonged survival as a result of more effective intracranial and extracranial treatment modalities. The cerebellum is the most common site of metastasis, thus new onset gait difficulties in patients with gastrointestinal cancer should be evaluated immediately because early recognition of focal neurologic symptoms can lead to prolonged survival and improved quality of life. Pre-operative neuroimaging is only indicated in patients with neurologic symptoms or those with large, late-stage GI tumors. Survival among patients with brain metastases from primary GI cancers is significantly diminished compared with breast, lung, or renal cell cancers. However, increased survival and improvement in clinical symptoms allowing greater functional dependence is achievable with both SR and SRS in select patients.3, 6, 45, 58-60 It is important to emphasize, however, that patients who are considered for neurosurgical intervention are those who demonstrate good prognostic factors, and this selection bias may be responsible for the apparent success of surgical intervention in prolonging survival. Although the addition of WBRT does not significantly enhance postoperative survival following SR or SRS, it may reduce the likelihood of recurrence, increase the time to recurrence, and minimize the chance of death from neurologic complications.