Critical Reviews in Oncology/Hematology 85 (2013) 32–44 Brain metastases from gastrointestinal tumours: Tailoring the approach to maximize the outcome Jessica Menis * , Caterina Fontanella, Alessandro Follador, Gianpiero Fasola, Giuseppe Aprile Department of Medical Oncology, University Hospital of Udine, Italy Accepted 11 April 2012 Contents 1. Introduction ........................................................................................................... 33 1.1. Esophageal and gastric cancers ................................................................................... 33 1.2. Colorectal cancers ............................................................................................... 33 1.3. Pancreatic cancer ................................................................................................ 34 1.4. Hepatobiliary cancer ............................................................................................ 34 2. Treatment ............................................................................................................ 35 2.1. Neurosurgery ................................................................................................... 35 2.2. Stereotactic radio-surgery ........................................................................................ 36 2.3. Radiotherapy ................................................................................................... 37 2.4. Combining treatments to maximize the strategy’s outcome in patients with limited brain disease ........................ 37 2.5. Chemotherapy .................................................................................................. 37 2.6. Biological agents ................................................................................................ 39 2.7. Palliative medical care ........................................................................................... 39 2.7.1. Corticosteroids and mannitol ............................................................................. 39 2.7.2. Anticonvulsivants ....................................................................................... 39 3. Clinically prognostic factors: forecasting who should receive aggressive treatment ........................................... 40 4. Translational research and future directions .............................................................................. 40 5. Conclusions ........................................................................................................... 40 Conflict of interest statement ........................................................................................... 41 Reviewers ............................................................................................................ 41 References ............................................................................................................ 41 Biography ............................................................................................................ 44 Abstract Brain metastases from the gastrointestinal cancers (GI) are uncommon, but their incidence is constantly increasing due to several reasons, including improved systemic therapy and survival. Nevertheless, the average outcome of these patients is poor and related to patients’ or disease characteristics, and to the availability of treatment options. Because of the lack of evidence-based recommendations, no optimal treatment strategy has been defined. The approach to brain metastases remains often tailored, and the action plan is selected on the basis of their number, size and location, the presence of symptoms and the extra-cranial disease status. Clinical prognostic factors have been identified and grouped into index scores that can be helpful in the treatment decision making. At the same time, molecular factors contributing to brain * Corresponding author at: Department of Medical Oncology, Piazzale Santa Maria della Misericordia, University Hospital Santa Maria della Misericordia, 33100 Udine, Italy. Tel.: +39 0432 552751; fax: +39 0432 552762. E-mail address: jessica.menis@libero.it (J. Menis). 1040-8428/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.critrevonc.2012.04.001