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BMC Cancer
Published in: BMC Cancer 1/2016

Open Access 01-12-2016 | Research article

Is upfront stereotactic radiosurgery a rational treatment option for very elderly patients with brain metastases? A retrospective analysis of 106 consecutive patients age 80 years and older

Authors: Shoji Yomo, Motohiro Hayashi

Published in: BMC Cancer | Issue 1/2016

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Abstract

Background

Advanced age has been shown to be a factor predicting poor survival in patients with brain metastases (BM). There have been only a few studies focusing on stereotactic radiosurgery (SRS) for elderly BM patients. The present study aimed to investigate the efficacy and limitations of SRS for very elderly BM patients.

Methods

This was a retrospective observational study analyzing 106 consecutive patients (69 males/37 females) age 80 years and older who received upfront Gamma Knife SRS for BM between January 2009 and October 2015. The median age was 84 years, and the median Karnofsky performance status (KPS) was 70. Fifty-two patients had a solitary BM, and others multiple BM. The median cumulative tumor volume was 3.9 mL and the median dose prescribed was 20 Gy. Overall survival (OS), neurological death rates and distant and local intracranial tumor control rates were analyzed.

Results

No patients were lost to follow-up. Six-month and 12-month OS rates were 54% and 32%, respectively. The median OS time was 7.1 months. Competing risks analysis showed that 6-month and 12-month neurological death rates were 8% and 11%, respectively. In total, 245 / 311 tumors (79%) in 82 patients (77%) with sufficient radiological follow-up data were evaluated. Six-month and 12-month distant BM recurrence rates (per patient) after SRS were 17% and 25%, respectively. Six-month and 12-month rates of local tumor control (per lesion) were 94% and 89%, respectively. Repeat SRS, salvage WBRT and surgical resection were subsequently required in 25, 4 and 1 patient, respectively. Proportional hazard regression analysis showed that KPS ≥ 70 (HR: 0.444, P < .001), controlled primary disease/no extracranial metastases (HR: 0.361, P < .001) and female sex (HR: 0.569, P = 0.028) were independent factors predicting better OS. Similarly, tumor volume (>2 mL) was the only factor predicting a higher rate of local control failure (HR: 12.8, P = 0.003).

Conclusions

The present study suggested an upfront SRS strategy to offer a feasible and effective treatment option for very elderly patients with limited BM. In the majority of patients, neurological death could be delayed or even prevented.
Literature
1.
Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31(2):128–36.CrossRefPubMed
2.
Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997;37(4):745–51.CrossRefPubMed
3.
Lagerwaard FJ, Levendag PC, Nowak PJ, Eijkenboom WM, Hanssens PE, Schmitz PI. Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys. 1999;43(4):795–803.CrossRefPubMed
4.
Lutterbach J, Bartelt S, Momm F, Becker G, Frommhold H, Ostertag C. Is older age associated with a worse prognosis due to different patterns of care? A long-term study of 1346 patients with glioblastomas or brain metastases. Cancer. 2005;103(6):1234–44.CrossRefPubMed
5.
Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W. A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys. 2008;70(2):510–4.CrossRefPubMed
6.
Windsor AA, Koh ES, Allen S, Gabriel GS, Yeo AE, Allison R, van der Linden YM, Barton MB. Poor outcomes after whole brain radiotherapy in patients with brain metastases: results from an international multicentre cohort study. Clin Oncol. 2013;25(11):674–80.CrossRef
7.
Kong W, Jarvis CR, Sutton DS, Ding K, Mackillop WJ. The use of palliative whole brain radiotherapy in the management of brain metastases. Clin Oncol. 2012;24(10):e149–158.CrossRef
8.
Tsao M, Xu W, Sahgal A. A meta-analysis evaluating stereotactic radiosurgery, whole-brain radiotherapy, or both for patients presenting with a limited number of brain metastases. Cancer. 2012;118(9):2486–93.CrossRefPubMed
9.
Soffietti R, Kocher M, Abacioglu UM, Villa S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, et al. A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. J Clin Oncol. 2013;31(1):65–72.CrossRefPubMed
10.
Yamamoto M, Serizawa T, Shuto T, Akabane A, Higuchi Y, Kawagishi J, Yamanaka K, Sato Y, Jokura H, Yomo S, et al. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol. 2014;15(4):387–95.CrossRefPubMed
11.
Sahgal A, Aoyama H, Kocher M, Neupane B, Collette S, Tago M, Shaw P, Beyene J, Chang EL. Phase 3 trials of stereotactic radiosurgery with or without whole-brain radiation therapy for 1 to 4 brain metastases: individual patient data meta-analysis. Int J Radiat Oncol Biol Phys. 2015;91(4):710–7.CrossRefPubMed
12.
Noel G, Bollet MA, Noel S, Feuvret L, Boisserie G, Tep B, Delattre JY, Baillet F, Ambroise Valery C, Cornu P, et al. Linac stereotactic radiosurgery: an effective and safe treatment for elderly patients with brain metastases. Int J Radiat Oncol Biol Phys. 2005;63(5):1555–61.CrossRefPubMed
13.
Kim SH, Weil RJ, Chao ST, Toms SA, Angelov L, Vogelbaum MA, Suh JH, Barnett GH. Stereotactic radiosurgical treatment of brain metastases in older patients. Cancer. 2008;113(4):834–40.CrossRefPubMed
14.
Minniti G, Esposito V, Clarke E, Scaringi C, Bozzao A, Lanzetta G, De Sanctis V, Valeriani M, Osti M, Enrici RM. Stereotactic radiosurgery in elderly patients with brain metastases. J Neurooncol. 2013;111(3):319–25.CrossRefPubMed
15.
Watanabe S, Yamamoto M, Sato Y, Kawabe T, Higuchi Y, Kasuya H, Yamamoto T, Matsumura A, Barfod BE. Stereotactic radiosurgery for brain metastases: a case-matched study comparing treatment results for patients 80 years of age or older versus patients 65–79 years of age. J Neurosurg. 2014;121(5):1148–57.CrossRefPubMed
16.
Park JY, Moon KS, Lee KH, Lim SH, Jang WY, Lee H, Jung TY, Kim IY, Jung S. Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival. BMC Cancer. 2015;15:54.CrossRefPubMedPubMedCentral
17.
Yomo S, Hayashi M. A minimally invasive treatment option for large metastatic brain tumors: long-term results of two-session Gamma Knife stereotactic radiosurgery. Radiat Oncol. 2014;9:132.CrossRefPubMedPubMedCentral
18.
Liu L, Bassano DA, Prasad SC, Hahn SS, Chung CT. The linear-quadratic model and fractionated stereotactic radiotherapy. Int J Radiat Oncol Biol Phys. 2003;57(3):827–32.CrossRefPubMed
19.
Kano H, Kondziolka D, Lobato-Polo J, Zorro O, Flickinger JC, Lunsford LD. T1/T2 matching to differentiate tumor growth from radiation effects after stereotactic radiosurgery. Neurosurgery. 2010;66(3):486–91. discussion 491–482.CrossRefPubMed
20.
Gray RJ. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16(3):1141–54.CrossRef
21.
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94(446):496–509.CrossRef
22.
Baschnagel AM, Meyer KD, Chen PY, Krauss DJ, Olson RE, Pieper DR, Maitz AH, Ye H, Grills IS. Tumor volume as a predictor of survival and local control in patients with brain metastases treated with Gamma Knife surgery. J Neurosurg. 2013;119(5):1139–44.CrossRefPubMed
23.
Yomo S, Hayashi M. The efficacy and limitations of stereotactic radiosurgery as a salvage treatment after failed whole brain radiotherapy for brain metastases. J Neurooncol. 2013;113(3):459–65.CrossRefPubMed
24.
Sasaki T, Izawa M, Okada Y. Current trends in health insurance systems: OECD countries vs. Japan. Neurol Med Chir. 2015;55(4):267–75.CrossRef
25.
DALYs GBD, Collaborators H, Murray CJ, Barber RM, Foreman KJ, Ozgoren AA, Abd-Allah F, Abera SF, Aboyans V, Abraham JP, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet. 2015.
26.
Goodwin JS, Hunt WC, Samet JM. Determinants of cancer therapy in elderly patients. Cancer. 1993;72(2):594–601.CrossRefPubMed
27.
Yomo S, Hayashi M, Cho N. Impacts of HER2-overexpression and molecular targeting therapy on the efficacy of stereotactic radiosurgery for brain metastases from breast cancer. J Neurooncol. 2013;112(2):199–207.CrossRefPubMed
28.
Yomo S, Hayashi M. Is stereotactic radiosurgery a rational treatment option for brain metastases from small cell lung cancer? A retrospective analysis of 70 consecutive patients. BMC Cancer. 2015;15:95.CrossRefPubMedPubMedCentral
29.
Molenaar R, Wiggenraad R, Verbeek-de Kanter A, Walchenbach R, Vecht C. Relationship between volume, dose and local control in stereotactic radiosurgery of brain metastasis. Br J Neurosurg. 2009;23(2):170–8.CrossRefPubMed
30.
Sneed PK, Mendez J, Vemer-van den Hoek JG, Seymour ZA, Ma L, Molinaro AM, Fogh SE, Nakamura JL, McDermott MW. Adverse radiation effect after stereotactic. radiosurgery for brain metastases: incidence, time course, and risk factors. J Neurosurg. 2015;123(2):373–86.CrossRefPubMed
31.
Brown JM, Carlson DJ, Brenner DJ. The tumor radiobiology of SRS and SBRT: are more than the 5 Rs involved? Int J Radiat Oncol Biol Phys. 2014;88(2):254–62.CrossRefPubMedPubMedCentral
32.
Garcia-Barros M, Paris F, Cordon-Cardo C, Lyden D, Rafii S, Haimovitz-Friedman A, Fuks Z, Kolesnick R. Tumor response to radiotherapy regulated by endothelial cell apoptosis. Science. 2003;300(5622):1155–9.CrossRefPubMed
33.
Fuks Z, Kolesnick R. Engaging the vascular component of the tumor response. Cancer cell. 2005;8(2):89–91.CrossRefPubMed
34.
Ernst-Stecken A, Ganslandt O, Lambrecht U, Sauer R, Grabenbauer G. Phase II trial of hypofractionated stereotactic radiotherapy for brain metastases: results and toxicity. Radiother Oncol. 2006;81(1):18–24.CrossRefPubMed
35.
Oermann EK, Kress MA, Todd JV, Collins BT, Hoffman R, Chaudhry H, Collins SP, Morris D, Ewend MG. The impact of radiosurgery fractionation and tumor radiobiology on the local control of brain metastases. J Neurosurg. 2013;119(5):1131–8.CrossRefPubMed
36.
Hanssens P, Karlsson B, Yeo TT, Chou N, Beute G. Detection of brain micrometastases by high-resolution stereotactic magnetic resonance imaging and its impact on the timing of and risk for distant recurrences. J Neurosurg. 2011;115(3):499–504.CrossRefPubMed
37.
Aoyama H, Tago M, Kato N, Toyoda T, Kenjyo M, Hirota S, Shioura H, Inomata T, Kunieda E, Hayakawa K, et al. Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone. Int J Radiat Oncol Biol Phys. 2007;68(5):1388–95.CrossRefPubMed
Metadata
Title
Is upfront stereotactic radiosurgery a rational treatment option for very elderly patients with brain metastases? A retrospective analysis of 106 consecutive patients age 80 years and older
Authors
Shoji Yomo
Motohiro Hayashi
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2016
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-016-2983-9

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