title: Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival.
abstract: BACKGROUND
  Gamma knife radiosurgery (GKRS) has been increasingly employed for the treatment of elderly patients with brain metastases, mainly due to its demonstrated effectiveness and low complication rate. However, only a few studies have investigated the prognostic factors that influence the survival of elderly patients after GKRS. The purpose of this study was to identify a scoring system that is able to predict the survival of elderly patients undergoing GKRS using data obtained at the time of diagnosis for brain metastases.
  
  
  METHODS
  Between 2004 and 2011, death was confirmed in 147 patients aged 70 years and older who had been treated with GKRS for brain metastases. Median age at the time of GKRS was 75.7 years (range, 70-86 years). The median tumor volume was 5.1 cm(3) (range, 0.05-59.9 cm(3)). The median marginal prescription dose was 21.4 Gy (range, 14-25 Gy).
  
  
  RESULTS
  The median survival was 167 days. Overall survival rates at 6 months and 1 year were 60.4% and 29.4%, respectively. Among the patient characteristics pertaining to systemic cancer and brain metastasis for which data were obtained preoperatively, a multivariate analysis showed that low Karnofsky performance status (KPS ≤ 80, P = 0.047) and the presence of extracranial metastases (P = 0.014) detected at the time of brain metastasis diagnosis were independent prognostic factors for short survival. A high score index for radiosurgery (SIR score ≥ 4, P = 0.024) and a high graded prognostic assessment (GPA score ≥ 2, P = 0.004) were associated with longer survival. A multivariate analysis of the important characteristics of systemic cancer, and the scoring system evaluating survival duration showed that a low GPA score was the most powerful independent factor for predicting short survival (hazard ratio 1.756, 95% confidence interval 1.252-2.456, P = 0.001).
  
  
  CONCLUSIONS
  GKRS is a safe approach to treat brain metastases in patients age 70 years and older. In this group, our study identified GPA score at the time of GKRS as a powerful prognostic factor for survival.
authors.affiliation: Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea. bleu058@hanmail.net.
authors.forename: Jae-Young
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea. moonks@chonnam.ac.kr.
authors.forename: Kyung-Sub
authors.initials: KS
authors.lastname: Moon
authors.affiliation: Department of Pathology, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea. mdkaylee@gmail.com.
authors.forename: Kyung-Hwa
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea. sahoe@cnuh.com.
authors.forename: Sa-Hoe
authors.initials: SH
authors.lastname: Lim
authors.affiliation: Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea. breadot@hanmail.net.
authors.forename: Woo-Youl
authors.initials: WY
authors.lastname: Jang
authors.affiliation: Department of Industrial & Management Engineering, Pohang University of Science and Technology, Pohang, South Korea. hyelee@postech.ac.kr.
authors.forename: Hyeseon
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea. jung-ty@chonnam.ac.kr.
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Jung
authors.affiliation: Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea. kiy87@hanmail.net.
authors.forename: In-Young
authors.initials: IY
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea. sjung@chonnam.ac.kr.
authors.forename: Shin
authors.initials: S
authors.lastname: Jung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D017567:Karnofsky Performance Status; D016634:Radiosurgery / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome