TY - JOUR
T1 - Comparison of different treatment approaches for one to two brain metastases in elderly patients
AU - Rades, Dirk
AU - Pluemer, Andre
AU - Veninga, Theo
AU - Schild, Steven E.
PY - 2008/11
Y1 - 2008/11
N2 - Background and Purpose: 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. Patients and Methods: One-hundred-and-sixty-four patients aged ≥ 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. Conclusion: 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.
AB - Background and Purpose: 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. Patients and Methods: One-hundred-and-sixty-four patients aged ≥ 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. Conclusion: 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.
KW - Brain metastases
KW - Elderly patients
KW - Neurosurgery
KW - Stereotactic radiosurgery
KW - Whole-brain radiotherapy
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U2 - 10.1007/s00066-008-1908-1
DO - 10.1007/s00066-008-1908-1
M3 - Article
C2 - 19016014
AN - SCOPUS:56549088597
SN - 0179-7158
VL - 184
SP - 565
EP - 571
JO - Strahlentherapie und Onkologie
JF - Strahlentherapie und Onkologie
IS - 11
ER -