Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2015

Open Access 01-12-2015 | Research article

Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival

Authors: Jae-Young Park, Kyung-Sub Moon, Kyung-Hwa Lee, Sa-Hoe Lim, Woo-Youl Jang, Hyeseon Lee, Tae-Young Jung, In-Young Kim, Shin Jung

Published in: BMC Cancer | Issue 1/2015

Login to get access

Abstract

Background

Gamma knife radiosurgery (GKRS) has been increasingly employed for the treatment of elderly patients with brain metastases, mainly due to its demonstrated effectiveness and low complication rate. However, only a few studies have investigated the prognostic factors that influence the survival of elderly patients after GKRS. The purpose of this study was to identify a scoring system that is able to predict the survival of elderly patients undergoing GKRS using data obtained at the time of diagnosis for brain metastases.

Methods

Between 2004 and 2011, death was confirmed in 147 patients aged 70 years and older who had been treated with GKRS for brain metastases. Median age at the time of GKRS was 75.7 years (range, 70–86 years). The median tumor volume was 5.1 cm3 (range, 0.05–59.9 cm3). The median marginal prescription dose was 21.4 Gy (range, 14–25 Gy).

Results

The median survival was 167 days. Overall survival rates at 6 months and 1 year were 60.4% and 29.4%, respectively. Among the patient characteristics pertaining to systemic cancer and brain metastasis for which data were obtained preoperatively, a multivariate analysis showed that low Karnofsky performance status (KPS ≤ 80, P = 0.047) and the presence of extracranial metastases (P = 0.014) detected at the time of brain metastasis diagnosis were independent prognostic factors for short survival. A high score index for radiosurgery (SIR score ≥ 4, P = 0.024) and a high graded prognostic assessment (GPA score ≥ 2, P = 0.004) were associated with longer survival. A multivariate analysis of the important characteristics of systemic cancer, and the scoring system evaluating survival duration showed that a low GPA score was the most powerful independent factor for predicting short survival (hazard ratio 1.756, 95% confidence interval 1.252–2.456, P = 0.001).

Conclusions

GKRS is a safe approach to treat brain metastases in patients age 70 years and older. In this group, our study identified GPA score at the time of GKRS as a powerful prognostic factor for survival.
Literature
1.
Lu-Emerson C, Eichler AF. Brain metastases. Continuum (Minneap Minn). 2012;18(2):295–311.
2.
Nieder C, Nestle U, Walter K, Niewald M, Schnabel K. Dose–response relationships for radiotherapy of brain metastases: role of intermediate-dose stereotactic radiosurgery plus whole-brain radiotherapy. Am J Clin Oncol. 2000;23(6):584–8.CrossRefPubMed
3.
Shimamoto S, Inoue T, Shiomi H, Sumida I, Yamada Y, Tanaka E, et al. CyberKnife stereotactic irradiation for metastatic brain tumors. Radiat Med. 2002;20(6):299–304.PubMed
4.
Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31(2):128–36.CrossRefPubMed
5.
6.
Rades D, Kueter JD, Veninga T, Gliemroth J, Schild SE. Whole brain radiotherapy plus stereotactic radiosurgery (WBRT + SRS) versus surgery plus whole brain radiotherapy (OP + WBRT) for 1–3 brain metastases: results of a matched pair analysis. Eur J Cancer. 2009;45(3):400–4.CrossRefPubMed
7.
Minniti G, Esposito V, Clarke E, Scaringi C, Bozzao A, Lanzetta G, et al. Stereotactic radiosurgery in elderly patients with brain metastases. J Neurooncol. 2013;111(3):319–25.CrossRefPubMed
8.
DeAngelis LM, Delattre JY, Posner JB. Radiation-induced dementia in patients cured of brain metastases. Neurology. 1989;39(6):789–96.CrossRefPubMed
9.
Aoyama H, Tago M, Kato N, Toyoda T, Kenjyo M, Hirota S, 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
10.
Pan HC, Sheehan J, Stroila M, Steiner M, Steiner L. Gamma knife surgery for brain metastases from lung cancer. J Neurosurg. 2005;102(Suppl):128–33.CrossRefPubMed
11.
Nieder C, Bremnes RM, Andratschke NH. Prognostic scores in patients with brain metastases from non-small cell lung cancer. J Thorac Oncol. 2009;4(11):1337–41.CrossRefPubMed
12.
Weltman E, Salvajoli JV, Brandt RA, de Morais HR, Prisco FE, Cruz JC, et al. Radiosurgery for brain metastases: a score index for predicting prognosis. Int J Radiat Oncol Biol Phys. 2000;46(5):1155–61.CrossRefPubMed
13.
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
14.
Lorenzoni J, Devriendt D, Massager N, David P, Ruiz S, Vanderlinden B, et al. Radiosurgery for treatment of brain metastases: estimation of patient eligibility using three stratification systems. Int J Radiat Oncol Biol Phys. 2004;60(1):218–24.CrossRefPubMed
15.
Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, et al. 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
16.
Erikson C, Salsberg E, Forte G, Bruinooge S, Goldstein M. Future supply and demand for oncologists: challenges to assuring access to oncology services. J Oncol Pract. 2007;3(2):79–86.CrossRefPubMedPubMedCentral
17.
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
18.
19.
Goodwin JS, Hunt WC, Samet JM. A population-based study of functional status and social support networks of elderly patients newly diagnosed with cancer. Arch Intern Med. 1991;151(2):366–70.CrossRefPubMed
20.
Goodwin JS, Hunt WC, Samet JM. Determinants of cancer therapy in elderly patients. Cancer. 1993;72(2):594–601.CrossRefPubMed
21.
Arriagada R. Re: Prophylactic cranial irradiation for patients with small-cell lung cancer. J Natl Cancer Inst. 1995;87(10):766. author reply 767.CrossRefPubMed
22.
Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA. 2006;295(21):2483–91.CrossRefPubMed
23.
Crossen JR, Garwood D, Glatstein E, Neuwelt EA. Neurobehavioral sequelae of cranial irradiation in adults: a review of radiation-induced encephalopathy. J Clin Oncol. 1994;12(3):627–42.PubMed
24.
Mehta M, Noyes W, Craig B, Lamond J, Auchter R, French M, et al. A cost-effectiveness and cost-utility analysis of radiosurgery vs. resection for single-brain metastases. Int J Radiat Oncol Biol Phys. 1997;39(2):445–54.CrossRefPubMed
25.
Cairncross JG, Kim JH, Posner JB. Radiation therapy for brain metastases. Ann Neurol. 1980;7(6):529–41.CrossRefPubMed
26.
Weissman DE. Glucocorticoid treatment for brain metastases and epidural spinal cord compression: a review. J Clin Oncol. 1988;6(3):543–51.PubMed
27.
Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322(8):494–500.CrossRefPubMed
28.
Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010;77(3):655–61.CrossRefPubMed
29.
Kim SH, Weil RJ, Chao ST, Toms SA, Angelov L, Vogelbaum MA, et al. Stereotactic radiosurgical treatment of brain metastases in older patients. Cancer. 2008;113(4):834–40.CrossRefPubMed
30.
Watanabe S, Yamamoto M, Sato Y, Kawabe T, Higuchi Y, Kasuya H, et al. 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
31.
Lowry JK, Snyder JJ, Lowry PW. Brain tumors in the elderly: recent trends in a Minnesota cohort study. Arch Neurol. 1998;55(7):922–8.CrossRefPubMed
Metadata
Title
Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival
Authors
Jae-Young Park
Kyung-Sub Moon
Kyung-Hwa Lee
Sa-Hoe Lim
Woo-Youl Jang
Hyeseon Lee
Tae-Young Jung
In-Young Kim
Shin Jung
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2015
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-015-1070-y

Other articles of this Issue 1/2015

BMC Cancer 1/2015 Go to the issue

Research article

High-density SNP arrays improve detection of HER2 amplification and polyploidy in breast tumors

Research article

Cell fusion between gastric epithelial cells and mesenchymal stem cells results in epithelial-to-mesenchymal transition and malignant transformation

Research article

Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists

Research article

Altered PPP2R2A and Cyclin D1 expression defines a subgroup of aggressive luminal-like breast cancer

Research article

Framing overdiagnosis in breast screening: a qualitative study with Australian experts

Research article

The different role of intratumoral and peritumoral lymphangiogenesis in gastric cancer progression and prognosis
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits