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Stereotactic radiosurgery improves survival in older patients with brain metastases

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Patients aged 75 years and older with brain metastases respond about as well as younger patients to stereotactic radiosurgery (SRS), according to a report in the August 15th issue of Cancer.

Several studies have demonstrated the survival advantage of treating brain metastases with SRS, the authors explain, but there has been no detailed examination of the utility of SRS in patients aged 65 years and older.

Dr. Se-Hyuk Kim from the Cleveland Clinic Foundation, Ohio and colleagues performed a retrospective analysis of a consecutive series of 44 patients at least 75 years old with brain metastases treated with SRS and followed for up to 2.5 years.

Median overall survival was 7.3 months from the diagnosis of brain metastases, the authors report, with actuarial survival rates of 86.4% at 3 months, 68.2% at 6 months, 45.5% at 9 months, and 34.1% at 12 months.

Median survival was longer in patients with a single brain metastasis (10.1 months) than in those with two or more brain metastases (6.6 months), the report indicates.

Seventeen patients whose primary tumor was non-small-cell lung carcinoma had significantly shorter median survival (6.5 months) than did the other 27 patients (10.1 months), the researchers note.

Five of 26 patients with a repeat neuroradiological imaging examination at a median of 3.8 months had a new, distant brain metastasis, which was treated successfully with SRS in the four patients who returned to the clinic.

“The current study results suggest that stereotactic radiosurgical treatment of patients aged 75 years and older with brain metastases, with a good functional status, less extra-CNS disease, and a reasonable expectation for survival after SRS, is an effective and safe treatment modality that prolongs survival, has an excellent functional outcome, and provides results that are similar to those noted in younger patients,” Dr. Kim and colleagues conclude.

“Based on our outcomes,” they add, “we will continue to offer SRS for patients with brain metastases who are aged 75 years and older.”

Cancer 2008;113:834-840.