Stereotactic radiosurgical treatment of brain metastases in older patients.
BACKGROUND
This study was designed to evaluate the therapeutic effect of stereotactic radiosurgery (SRS) in patients aged > or =75 years who presented with brain metastasis.


METHODS
The authors analyzed the data from 44 consecutive patients treated with SRS for > or =1 brain metastasis. The median age at the time of treatment for brain metastases was 79.3 years (range, 75 years-86 years), and the median Karnofsky performance status was 80 (range, 50-100). At the time of SRS, 31 patients were treated for a single metastasis, and the remaining 13 patients were treated for > or =2 lesions (n = 74 lesions). The median tumor volume was 1.2 cm(3) (range, 0.007 cm(3)-22.5 cm(3)). The median maximal and marginal doses were 36 grays (Gy) (range, 18.8 Gy-48.2 Gy) and 20 Gy (range, 10 Gy-24 Gy), respectively.


RESULTS
Median survival was 7.3 +/- 1.65 months (range, 1.6 months-38.9 months) from the time of diagnosis of brain metastasis. Median survival of the patients with a single brain metastasis (10.1 +/- 1.92 months) was longer than that of the patients with > or =2 metastases (6.6 +/- 1.28 months) (P <.02). A single lesion was found to be an independent favorable prognostic factor (P +/- = +/- .017; odds ratio, 2.385 [95% confidence interval, 1.167-4.874]) in univariate and multivariate analysis. Patients with nonsmall cell lung cancer fared worse than patients with other tumor types (survival of 6.5 +/- 0.70 months vs 10.1 +/- 2.33 months [P<.05]).


CONCLUSIONS
SRS for patients aged > or =75 years with brain metastases is an effective and safe treatment modality that appears to improve survival, with outcomes that compare favorably with those reported for younger patients in an appropriately selected population.
The Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Se-Hyuk
SH
Kim
Robert J
RJ
Weil
Samuel T
ST
Chao
Steven A
SA
Toms
Lilyana
L
Angelov
Michael A
MA
Vogelbaum
John H
JH
Suh
Gene H
GH
Barnett
D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D016634:Radiosurgery; D012189:Retrospective Studies; D016019:Survival Analysis