Stereotactic radiosurgery of brain metastases in elderly patients: the cleveland clinic experience

Manmeet Ahluwalia1, Neda Hashemi-Sadraei2, John Suh3, Sam Chao2, Lilyana Angelov1, Robert Weil2, Michael Vogelbaum2, Paul Elson4, Gene Barnett2

1Cleveland, United States 2Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic 3Taussig Cancer Institute, Cleveland Clinic 4Quantitative Health Sciences, Cleveland Clinic

Keywords: elderly, outcome, gamma knife, radiosurgery, brain metastasis

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Abstract

     Elderly patients often suffer from cerebrovascular impairment. Whole brain radiotherapy (WBRT) can cause vascular damage and enhances the risk of dementia. For patients with a limited number of brain metastases (BM) stereotactic radiosurgery (SRS) is promising alternative.
     This study was designed to evaluate the therapeutic effect of SRS in patients aged >70 years who presented with brain metastases.
     The IRB-approved Cleveland Clinic Brain Tumor and Neuro-Oncology Center’s database was used to identify patients with BM who were >70 years at the time of diagnosis of BM and were treated with SRS between 8/2000 and 12/2009.
       Multivariable analysis was conducted to identify independent predictors of survival using a Cox proportional hazards model and a stepwise selection algorithm with p=0.10 and p=0.05 as criteria for entry and retention.
     173 BM patients with a median age of 75 years (range 70-87, 64% male) were included. Most patients had either lung cancer (55%, 95/173) or kidney cancer (16%, 28/173) primaries. Median time between diagnosis of the primary cancer and BM was 10.3 months (0-309.6 months). Forty-six percent (79/173) of patients had multiple BM and 57% (99/173) had extra-cranial metastases at the time BM was diagnosed. Median overall survival (OS) was 5.5 months from the time of SRS (95% CI, 4.4-7.2 months). Cause of death was extracranial tumor progression in 35% of the patients, cranial tumor progression in only 3%, both cranial and extracranial tumor progression in 9%, and the cause of death was unknown in 53%.
     This was a retrospective series.
     In multivariable analysis, performance status, the interval from diagnosis of the primary cancer to BM, WBRT prior to SRS and presence of extracranial metastasis were all identified as independent predictors of OS.
     SRS for brain metastases is a well tolerated and effective treatment for elderly patients.


Acknowledgements

Project Roles:

M. Ahluwalia (), N. Hashemi-Sadraei (), J. Suh (), S. Chao (), L. Angelov (), R. Weil (), M. Vogelbaum (), P. Elson (), G. Barnett ()