title: Comparison of different treatment approaches for one to two brain metastases in elderly patients.
abstract: OBJECTIVE
  Elderly patients are often treated differently than younger individuals due to concerns regarding tolerance and survival. This analysis was performed to evaluate whether elderly patients with one to two brain metastases would benefit from relatively aggressive approaches. It compares whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), resection plus WBRT (OP + WBRT), and resection plus WBRT plus boost (OP + WBRT + boost) in elderly patients.
  
  
  METHODS
  One-hundred-and-sixty-four patients aged > or = 65 years with one to two brain metastases treated with WBRT (n = 34), SRS (n = 43), OP + WBRT (n = 41), or OP + WBRT + boost (n = 46) were included. The groups were compared retrospectively regarding survival (OS), intracerebral control (IC), and local control of treated metastases (LC). Six additional potential prognostic factors were evaluated: gender, performance status, tumor type, number of brain metastases, extracerebral metastases, and interval from tumor diagnosis to irradiation.
  
  
  RESULTS
  1-year OS was 17% after WBRT, 40% after SRS, 27% after OP + WBRT, and 61% after OP + WBRT + boost. On multivariate analysis, treatment regimen (RR: 1.67; p = 0.043), no extracerebral metastases (RR: 2.85; p < 0.001), and longer interval from tumor diagnosis to irradiation (RR: 1.78; p = 0.002) were associated with improved OS. 1-year IC was 17%, 55%, 36%, and 79%, respectively. On multivariate analysis, treatment (RR: 2.83; p < 0.001), single brain metastasis (RR: 1.80; p = 0.021), and longer interval (RR: 2.02; p = 0.004) were associated with improved IC. 1-year LC was 19%, 68%, 43%, and 84%, respectively. On multivariate analysis, treatment (RR: 3.31; p < 0.001), single brain metastasis (RR: 1.76; p = 0.047), and longer interval (RR: 1.89; p = 0.015) were associated with improved LC.
  
  
  CONCLUSIONS
  OP + WBRT + boost appeared to provide the best outcomes of the compared treatment regimens in elderly patients with one to two brain metastases. If surgery is not possible, SRS may be considered.
authors.affiliation: Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. Rades.Dirk@gmx.net
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.forename: Andre
authors.initials: A
authors.lastname: Pluemer
authors.forename: Theo
authors.initials: T
authors.lastname: Veninga
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology; D002292:Carcinoma, Renal Cell / Q000473:pathology; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D016634:Radiosurgery