HighlightsNatural history of biliary cancers metastatic to boneThe role of skeletal events in patients with biliary cancerBiliary cancer and bone metastases: role of bisphosphonates

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14530 Background: Advances in systemic treatment for metastatic CRC confer survival advantage, allowing patients to reach a median survival of almost 2 years. As a consequence of this remarkable life extension, the incidence of BM from CRC, though still low, is increasing over time. The presence of BM is considered an index of poor prognosis, even when surgical resection is possible. Methods: To determine if an aggressive approach to BM from CRC could provide patients with clinical benefit or survival advantage, we retrospectively collected data from 29 CRC patients who underwent neurosurgical resection of BM between March 1998 and July 2006. Results: The median age at the time of surgical procedure was 65 years, median ECOG PS was 1, and the majority of patients (26 out of 29) had concomitant metastases at other sites. Lung and liver metastases were both common. Median number of previous chemotherapy regimens was two, with almost all of the patients being exposed both to oxaliplatinum and irinotecan-based regimens. After resection, 30 Gy of external whole-brain radiotherapy were administered to the majority of the patients. At the time of the analysis, 26 out of 29 patients had died, with a median survival time after brain metastasectomy of 210 days (8–682). Only 2 patients died within a month from surgery. We did observe prolonged survival for patients who received post-surgical radiotherapy (Kaplan Maier, p=0.033). Although death due to encephalic progression was reported for the patients with brain as the sole metastatic site, intracranial disease progression was not a clear predictor for poor survival in the whole cohort (p>0.05). Conclusions: Surgical resection of BM from CRC, whether followed by radiotherapy or not, is a feasible and safe technique, offering a chance of prolonged survival. Patients who received radiotherapy after complete neurosurgical resection have a better outcome. No significant financial relationships to disclose.