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Stereotactic radiosurgery in elderly patients with brain metastases

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Abstract

Stereotactic radiosurgery (SRS) has been increasingly employed as an alternative to whole brain radiation therapy in patients with brain metastases, with the aim to reduce its potential toxicity. We have evaluated clinical outcomes of SRS as initial treatment for brain metastases in patients 70 years and older. Between November 2007 and October 2011, 102 patients of 70 years and older with 1–4 metastases were treated with SRS. The primary end point of the study was overall survival. Secondary end points were local control and distant failure rates, cause of death, performance measurements, and toxicity of treatment. At a median follow-up of 11.0 months (range 1–48 months), median survival and median time to distant failure were 13.2 and 10 months, respectively. The 1- and 2-year survival rates were 63 and 28 %, and respective distant failure rates were 54 and 78 %. Forty-five patients succumbed to their extracranial disease and 14 patients died of progressive intracranial disease. Nine patients recurred locally after SRS. The 1- and 2-year local control rates were 90 and 84 %, respectively. Evaluation of neurocognitive function using the Mini-Mental State Examination (MMSE) showed no significant neurocognitive decline after SRS. MMSE score improved in 15 % of patients, worsened in 12 % of patients, and remained stable in the others. Severe neurological complications were reported in 7 (7 %) patients, requiring surgery or medical treatment. Initial treatment with SRS with close monitoring may represent a relatively safe treatment strategy associated with survival benefit, with outcomes similar to those reported in historical series of SRS for younger patients.

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Conflict of interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Unit of Radiation Oncology, Sant’ Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189, Rome, Italy

    Giuseppe Minniti, Enrico Clarke, Claudia Scaringi, Vitaliana De Sanctis, Maurizio Valeriani, Mattia Osti & Riccardo Maurizi Enrici

  2. Department of Neurological Sciences, IRCCS Neuromed, Pozzilli, 86077, Isernia, Italy

    Giuseppe Minniti, Vincenzo Esposito & Gaetano Lanzetta

  3. Unit of Neuroradiology, Sant’ Andrea Hospital, University Sapienza, 00189, Rome, Italy

    Alessandro Bozzao

Authors
  1. Giuseppe Minniti
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  2. Vincenzo Esposito
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  3. Enrico Clarke
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  4. Claudia Scaringi
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  5. Alessandro Bozzao
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  6. Gaetano Lanzetta
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  7. Vitaliana De Sanctis
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  8. Maurizio Valeriani
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  9. Mattia Osti
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  10. Riccardo Maurizi Enrici
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Correspondence to Giuseppe Minniti.

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Minniti, G., Esposito, V., Clarke, E. et al. Stereotactic radiosurgery in elderly patients with brain metastases. J Neurooncol 111, 319–325 (2013). https://doi.org/10.1007/s11060-012-1016-z

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  • DOI: https://doi.org/10.1007/s11060-012-1016-z

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