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Stereotactic radiosurgical treatment of brain metastases in older patients
Author(s) -
Kim SeHyuk,
Weil Robert J.,
Chao Samuel T.,
Toms Steven A.,
Angelov Lilyana,
Vogelbaum Michael A.,
Suh John H.,
Barnett Gene H.
Publication year - 2008
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23625
Subject(s) - medicine , radiosurgery , brain metastasis , confidence interval , metastasis , univariate analysis , odds ratio , performance status , multivariate analysis , lung cancer , nuclear medicine , cancer , surgery , radiation therapy , radiology
BACKGROUND. This study was designed to evaluate the therapeutic effect of stereotactic radiosurgery (SRS) in patients aged ≥75 years who presented with brain metastasis. METHODS. The authors analyzed the data from 44 consecutive patients treated with SRS for ≥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 ≥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 ≥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 ≥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. Cancer 2008. © 2008 American Cancer Society.