title: Stereotactic radiosurgery in elderly patients with brain metastases.
abstract: Stereotactic radiosurgery (SRS) has been increasingly employed as an alternative to whole brain radiation therapy in patients with brain metastases, with the aim to reduce its potential toxicity. We have evaluated clinical outcomes of SRS as initial treatment for brain metastases in patients 70 years and older. Between November 2007 and October 2011, 102 patients of 70 years and older with 1-4 metastases were treated with SRS. The primary end point of the study was overall survival. Secondary end points were local control and distant failure rates, cause of death, performance measurements, and toxicity of treatment. At a median follow-up of 11.0 months (range 1-48 months), median survival and median time to distant failure were 13.2 and 10 months, respectively. The 1- and 2-year survival rates were 63 and 28 %, and respective distant failure rates were 54 and 78 %. Forty-five patients succumbed to their extracranial disease and 14 patients died of progressive intracranial disease. Nine patients recurred locally after SRS. The 1- and 2-year local control rates were 90 and 84 %, respectively. Evaluation of neurocognitive function using the Mini-Mental State Examination (MMSE) showed no significant neurocognitive decline after SRS. MMSE score improved in 15 % of patients, worsened in 12 % of patients, and remained stable in the others. Severe neurological complications were reported in 7 (7 %) patients, requiring surgery or medical treatment. Initial treatment with SRS with close monitoring may represent a relatively safe treatment strategy associated with survival benefit, with outcomes similar to those reported in historical series of SRS for younger patients.
authors.affiliation: Unit of Radiation Oncology, Sant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, Italy. giuseppe.minniti@ospedalesantandrea.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Minniti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Esposito
authors.forename: Enrico
authors.initials: E
authors.lastname: Clarke
authors.forename: Claudia
authors.initials: C
authors.lastname: Scaringi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bozzao
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lanzetta
authors.forename: Vitaliana
authors.initials: V
authors.lastname: De Sanctis
authors.forename: Maurizio
authors.initials: M
authors.lastname: Valeriani
authors.forename: Mattia
authors.initials: M
authors.lastname: Osti
authors.forename: Riccardo Maurizi
authors.initials: RM
authors.lastname: Enrici
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008609:Mental Status Schedule; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate