John Libbey Eurotext

Bulletin du Cancer


LINAC radiosurgery for brain metastasis in elderly Volume 90, issue 10, Octobre 2003


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Service des tumeurs, Service de neurochirurgie, Service de neuroradiologie, Service de neurologie, Groupe Pitié‐Salpêtrière, AP‐HP, 47‐83, bd de l‘hôpital, 75651 Paris Cedex 13 Service de gériatrie, hôpital des Abondances, rue des Abondances, 92200 Boulogne‐Billancourt

Aims. Analysis of results of stereotactic irradiation for brain metastases for patients older than 70 years. Patients and methods. From January 1994 to January 2002, 53 patients received stereotactic irradiation for a total of 105 brain metastases. There were 26 females and 27 males. Median age was 73 years (70‐86). Median interval between cancer diagnosis and brain metastases was 18 months (0‐216). Metastases were diagnosed after development of related clinical symptoms in 34 patients (64.1%). Patients were irradiated for one to 6 metastases. Twenty‐nine patients (54.7%) were treated for only one metastasis. Median metastasis diameter and volume were respectively 24 mm (5‐74.9 mm) and 2.1 cc (0.02‐71.3). Eigthy‐three metastases were supratentorial (79%), and 22 subtentorial (21%). Forty‐five underwent only one procedure (85%) and 8 patients underwent a second procedure for one or several new metastases. Three patients were irradiated with whole brain radiotherapy (WBRT) concomitantly of radiosurgery and three patients received WBRT after radiosurgery for development of more than four metastases or for carcinomatous meningitis. Results. The median follow‐up was 8 months (1‐33). Median minimum and maximum doses delivered to the metastases were respectively, 16.42 Gy (6.5‐20.5) and 20.36 Gy (13.2‐41.9). The median overall survival duration was 9 months. Three‐, 6‐, 12‐ and 18‐month overall survival rates were respectively, 85.6% ± 5, 65.2% ± 7.1, 35.5% ± 7.8 and 26.6% ± 8. According to unifactorial analysis, two prognostic factors of overall survival were retrieved, extra‐cranial disease status and RPAa (Recursive Partitioning Analysis for aged patients) separated in three classes including Karnofsky index performance status and extra‐cranial disease status, respectively p ∓ 0.043 et p ∓ 0.016. According to multifactorial analysis only RPAa was an independent prognostic factor of overall survival (p ∓ 0.019, RR : 0.89, 95% confidence interval [0.017‐0.47]). Median brain disease‐free survival was 12 months. Three‐, 6‐, 12‐ and 18‐month free‐brain disease survival rates were, 81.5% ± 6.4, 68.7% ± 8, 47.2% ± 9.9 and 35.4 % ± 12.6, respectively. No prognostic factor of free‐brain disease survival was retrieved. Crude local control rate was 97%. Only three metastases relapsed. Six and 12‐month local control rates were 98.6% ± 1.4 and 88.5% ± 7.6. Among 34 patients with initial clinical symptoms, one patient presented an aggravation, 9 improved up to complete response (26.5%), 13 patients presented a partial remission (38.2%) and 5 were stabilized (14.7%). For 6 patients, data were not available. We observed 3 radionecroses and 1 hemorrhage of the metastases. Conclusion. Radiosurgery in the elderly was efficient and well tolerated. Age alone should not be used to deny potentially beneficial radiosurgery to any patient with brain metastases. ▴