Outcome of Elderly Patients With Surgically Treated Brain Metastases

Abstract

ObjectIn the light of an aging population and ongoing advances in cancer control, the optimal management in geriatric patients with brain metastases (BM) poses an increasing challenge, especially due to the scarce data available. We therefore analyzed our institutional data with regard to factors influencing overall survival (OS) in geriatric patients with BM.MethodsBetween 2013 and 2018, patients aged ≥ 65 years with surgically treated BM were included in this retrospective analysis. In search of preoperatively identifiable risk factors for poor OS, in addition to the underlying cancer, the preoperative frailty of patients was analyzed using the modified Frailty Index (mFI).ResultsA total of 180 geriatric patients with surgically treated BM were identified. Geriatric patients categorized as least-frail achieved a median OS of 18 months, whereas frailest patients achieved an OS of only 3 months (p<0.0001). Multivariable cox regression analysis detected “multiple intracranial metastases” (p=0.001), “infratentorial localization” (p=0.011), “preoperative CRP >5 mg/l” (p=0.01) and “frailest patients (mFI ≥ 0.27)” (p=0.002) as predictors for reduced OS in older patients undergoing surgical treatment for BM.ConclusionsIn this retrospective series, pre-operative frailty was associated with poor survival in elderly patients with BM requiring surgery. Our analyses warrant thorough counselling and support of affected elderly patients and their families.

Surgical excision and radiotherapy for brain metastasis from colorectal cancer: How frailty and comorbidity indices influence outcome

“…[34][35][36] Moreover, associations between patient frailty and survival outcomes after surgery for BM have also been reported in the literature. 36,37 In the WBRT subgroup, the results were similar to that of the overall analysis, with the number of BM and PNI shown to be independent survival prognosticators. Nonetheless, compared with the overall analysis, there was a slight difference in the WBRT subgroup results, which is the effect of the number of BM.…”

Preoperative Metastatic Brain Tumor-Associated Intracerebral Hemorrhage Is Associated With Dismal Prognosis

“…Age itself seems to play an equally important role with regard to OS in patients with surgically treated BM, as shown by the present multivariate analysis. Apart from intratumoral hemorrhage, (older) age is an important prognostic factor for overall survival in patients with BM (15)(16)(17). Older age might also lead to an increased correlating burden of comorbidities.…”

Surgical treatment of cerebellar metastases in elderly patients: A threshold that moves forward?

“… 2 , 6 , 23 , 24 , 25 Compared with supratentorial tumors, infratentorial ones were almost 1.5 times more likely to have complications. 26 , 27 Recently Proescholdt et al compared the results of surgery and adjuvant therapies between 325 older (≥65 years) and 492 younger patients showing that median survival after brain metastases resection differed significantly: 5.81 vs 8.12 months. In both groups patients who received postoperative systemic treatment showed significantly longer overall survival.…”

“…Although it is difficult to provide a reliable” quantitative measure” from the literature, elderly patients appear to be more fragile with respect to their younger counterpart. 27 , 35 …”