Comparison of different treatment approaches for one to two brain metastases in elderly patients

Dirk Rades, Andre Pluemer, Theo Veninga, Steven E. Schild

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)565-571
Number of pages7
JournalStrahlentherapie und Onkologie
Volume184
Issue number11
DOIs
StatePublished - Nov 1 2008

Keywords

  • Brain metastases
  • Elderly patients
  • Neurosurgery
  • Stereotactic radiosurgery
  • Whole-brain radiotherapy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Oncology

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