Prognostic Factors and Independent Validation of a Risk Stratification Model in Octogenarian Patients Irradiated for Brain Metastases

Abstract

Background/Aim: This study aimed at validation of a prognostic model, originally developed by Rades et al., in an age-restricted, particularly vulnerable subgroup of patients with brain metastases, because international variations in clinical practice and survival outcomes may impact on the performance of survival prediction tools. Materials and Methods: Retrospectively, data from a single institution were analyzed. The study included 50 patients managed with palliative whole-brain radiotherapy. The Rades et al. score was assigned and the resulting 3 prognostic strata compared. Results: The 3-month survival rates for the 3 strata were 0, 35 and 41%, respectively (p<0.001 pooled over all strata, log-rank test for Kaplan-Meier curves). However, the prognostic impact of extracranial metastases suggested by Rades et al., together with performance status and number of brain metastases in their study of 94 patients, was absent. In contrast, cancer type (better survival for breast and melanoma) and lack of steroid treatment were significant in the present study. Conclusion: The original Rades et al. score is a useful prognostic model in our validation database. However, additional factors appear to play a role and might therefore be considered when performing future large-scale studies.

How we treat octogenarians with brain metastases

“…Their median survival was 2.0 months and the authors proposed a survival score featuring three prognostic groups based on Eastern Cooperative Oncology Group (ECOG) performance status (PS), number of lesions (single versus multiple), and extracranial metastases (present versus absent). Nieder et al validated these results in an independent cohort of 50 patients (14). Median survival was 2.1 months.…”

“…Nieder et al. validated these results in an independent cohort of 50 patients ( 14 ). Median survival was 2.1 months.…”

“…The longest observed survival was 6.1 months in octogenarians managed with BSC. Given that survival after WBRT was disappointing ( 13 , 14 ), more efficacious, yet function-preserving SRS (or fractionated variants) should be considered, if KPS is ≥70 and active treatment is needed. Median survival in the literature was around 6 months.…”

“… Approaches selected in one of the authors’ institutions. All patients with brain metastases were monitored in a continuously updated database ( 14 , 17 ). BSC, best supportive care; RT, radiotherapy; Tx, treatment.…”