Linac stereotactic radiosurgery: An effective and safe treatment for elderly patients with brain metastases

Noël, Georges; Bollet, Marc A.; Noël, Sophie; Feuvret, L.; Boisserie, G.; Tep, Bernadette; Delattre, Jean‐Yves; Baillet, F; Valéry, Charles-Ambroise; Cornu, Philippe; Mazeron, Jean‐Jacques

doi:10.1016/j.ijrobp.2005.04.037

Cited by 50 publications

(35 citation statements)

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“…5 They reported that median survival from presentation with brain metastases was 5 months for 384 (53%) patients with single lesion and 3 months for 345 (47%) patients with multifocal disease. Similar general findings have been noted in prospective trials of WBRT, alone or with SRS, 8,13 in retrospective trials, 5,7,10,11 and in retrospective surgical series. 16 In the current series, only the number of brain metastases (single vs multiple) was found to be an independent prognostic factor of survival.…”

Section: Discussionsupporting

confidence: 78%

“…The median overall survival was 3.8 months from the first day of WBRT for patients aged <65 years and 2.6 months for patients aged !65 years (P 5 .0002). In a second study, Noel et al 7 retrospectively analyzed the outcomes of LINAC SRS for brain metastases in 117 patients aged !65 years; overall median survival time was 8 months from the patient's first SRS. In the series, the median survival of elderly patients aged !75 years who were treated with SRS was 7.3 months (range, 1.6 months-38.9 months) from the diagnosis of brain metastases, which is comparable to the somewhat younger population in the study by Noel et al By comparison, in the Radiation Therapy Oncology Group (RTOG) 9508 randomized trial of SRS with or without WBRT, the median survival of patients with a single brain metastasis, treated with both modalities, was 6.5 months.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, in spite of the known efficacy of SRS in treating patients with brain metastases, little is known of its utility in older patients. 7,8 As life expectancies continue to improve and the proportion of patients in this age group continues to rise, this is an important question to address.…”

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Stereotactic radiosurgical treatment of brain metastases in older patients

Kim

Weil

Chao

et al. 2008

Cancer

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BACKGROUND. This study was designed to evaluate the therapeutic effect of stereotactic radiosurgery (SRS) in patients aged ≥75 years who presented with brain metastasis. METHODS. The authors analyzed the data from 44 consecutive patients treated with SRS for ≥1 brain metastasis. The median age at the time of treatment for brain metastases was 79.3 years (range, 75 years–86 years), and the median Karnofsky performance status was 80 (range, 50–100). At the time of SRS, 31 patients were treated for a single metastasis, and the remaining 13 patients were treated for ≥2 lesions (n = 74 lesions). The median tumor volume was 1.2 cm3 (range, 0.007 cm3‐22.5 cm3). The median maximal and marginal doses were 36 grays (Gy) (range, 18.8 Gy‐48.2 Gy) and 20 Gy (range, 10 Gy‐24 Gy), respectively. RESULTS. Median survival was 7.3 ± 1.65 months (range, 1.6 months‐38.9 months) from the time of diagnosis of brain metastasis. Median survival of the patients with a single brain metastasis (10.1±1.92 months) was longer than that of the patients with ≥2 metastases (6.6±1.28 months) (P <.02). A single lesion was found to be an independent favorable prognostic factor (P±=±.017; odds ratio, 2.385 [95% confidence interval, 1.167‐4.874]) in univariate and multivariate analysis. Patients with nonsmall cell lung cancer fared worse than patients with other tumor types (survival of 6.5 ± 0.70 months vs 10.1 ± 2.33 months [P<.05]). CONCLUSIONS. SRS for patients aged ≥75 years with brain metastases is an effective and safe treatment modality that appears to improve survival, with outcomes that compare favorably with those reported for younger patients in an appropriately selected population. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Stereotactic radiosurgical treatment of brain metastases in older patients

Kim

Weil

Chao

et al. 2008

Cancer

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“…Data from many other studies have shown the significant benefits of radiosurgery for brain metastasis and suggest that number of metastases is not the limiting factor in terms of a successful outcome. 2,3,8,10 Longer survival, improved disease control, better quality of life, and improved neurocognitive function for patients with brain metastasis is becoming the norm.With an expanding treatment armamentarium including extirpation, local chemotherapy, and radiosurgery, neurosurgeons are much more involved in the care of patients with brain metastasis. Now, large series of patients with brain metastasis are demonstrating that survival is limited not by intracranial but by extracranial disease progression.…”

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confidence: 99%

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confidence: 99%