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Stereotactic radiosurgery in elderly patients with brain metastases: comparison with non-elderly patients using database of a multi-institutional prospective observational study (JLGK0901-Elderly)

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Abstract

Purpose

Stereotactic radiosurgery (SRS) has been increasingly used for elderly patients with brain metastases (BMs). However, no studies based on a large sample size have been reported. To compare SRS treatment results between elderly and non-elderly patients, we performed a subset study of elderly patients using our prospectively-accumulated multi-institution study database (JLGK0901 Study, Lancet Oncol 15:387–395, 2014).

Methods

During the 2009–2011 period, 1194 eligible patients undergoing gamma knife SRS alone for newly diagnosed BMs were enrolled in this study from 23 gamma knife facilities in Japan. Observation was discontinued at the end of 2013. The 1194 patients were divided into the two age groups, 693 elderly ( ≥ 65 years) and 501 non-elderly ( < 65 years) patients. Our study protocol neither set an upper age limit nor required dose de-escalation.

Results

Median post-SRS survival time was significantly shorter in the elderly than in the non-elderly patient group (10.3 vs 14.3 months, HR 1.380, 95% CI 1.218–1.563, p < 0.0001). However, regarding all secondary endpoints including neurological death, neurological deterioration, SRS-related complications, leukoencephalopathy, local recurrence, newly-developed tumors, meningeal dissemination, salvage SRS, whole brain radiotherapy and surgery and decreased mini-mental state examination scores, the elderly patient group was not inferior to the non-elderly patient group. In the 693 elderly patients, there was no post-SRS median survival time difference between those with 5–10 versus 2–4 tumors (10.8 vs 8.9 months, HR 0.936, 95% CI 0.744–1.167, p = 0.5601).

Conclusions

We conclude that elderly BM patients are not unfavorable candidates for SRS alone treatment.

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Acknowledgements

We are very grateful to all investigators of the JLGK Study Group who are not included as co-authors, as well as Ms. Yukiko Hanawa, Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, for her meticulous work in managing the database. We thank Bierta E. Barfod, Katsuta Hospital Mito GammaHouse, for her help with English editing.

Funding

JPY11,000,000 the Japanese Brain Foundation (Non-governmental organization).

Author information

Author notes

  1. Masaaki Yamamoto and Toru Serizawa have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan

    Yoshinori Higuchi

  2. Katsuta Hospital Mito GammaHouse, Nakane 5125-2, Hitachinaka, Ibaraki, 312-0011, Japan

    Masaaki Yamamoto

  3. Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan

    Toru Serizawa

  4. Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan

    Yasunori Sato

  5. Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Japan

    Takashi Shuto

  6. Gamma Knife Center, NTT Medical Center Tokyo, Tokyo, Japan

    Atsuya Akabane

  7. Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Japan

    Hidefumi Jokura & Jun Kawagishi

  8. Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Japan

    Shoji Yomo

  9. Gamma Knife House, Chiba Cerebral and Cardiovascular Center, Ichihara, Japan

    Osamu Nagano

  10. Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan

    Kazuhiro Yamanaka

  11. Department of Radiology, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan

    Hidefumi Aoyama

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  1. Yoshinori Higuchi
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Correspondence to Masaaki Yamamoto.

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11060_2019_3242_MOESM1_ESM.tif

Post-stereotactic radiosurgery survival according to two age groups in the six original cancer categories; non-small cell lung cancer (upper, left), small cell lung cancer (upper, right), breast cancer (middle, left), gastro-intestinal tract cancer (middle, right), kidney cancer (lower, left) and others (lower, right). X-axis; survival fraction, Y-axis; months after stereotactic radiosurgery. Supplementary material 1 (TIFF 2855 kb)

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Higuchi, Y., Yamamoto, M., Serizawa, T. et al. Stereotactic radiosurgery in elderly patients with brain metastases: comparison with non-elderly patients using database of a multi-institutional prospective observational study (JLGK0901-Elderly). J Neurooncol 144, 393–402 (2019). https://doi.org/10.1007/s11060-019-03242-8

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  • DOI: https://doi.org/10.1007/s11060-019-03242-8

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