The First Survival Score for Patients Aged ≥80 Years Irradiated for Brain Metastases

Abstract

Survival scores facilitate personalized cancer treatment. Due to demographic changes, very elderly patients are more prevalent than in the past. A score was developed in 94 patients aged ≥80 years undergoing whole-brain radiotherapy for brain metastases. Dose fractionation, treatment period, age, sex, performance score (ECOG-PS), tumor type, count of lesions, metastases outside the brain, and interval tumor diagnosis to radiotherapy were retrospectively evaluated. Independent predictors of survival were used for the score. Based on individual scoring points obtained from 3-month survival rates, prognostic groups were designed. Additionally, the score was compared to an existing tool developed in patients ≥65 years. ECOG-PS, count of lesions, and extra-cranial metastases were independent prognostic factors. Three groups were created (7, 10, and 13–16 points) with 3-month survival of 6%, 25%, and 67% (p < 0.001), respectively. Positive predictive values (PPVs) regarding death ≤3 and survival ≥3 months were 94% and 67% (new score) vs. 96% and 48% (existing tool), respectively. PPVs for survival ≥1 and ≥2 months were 88% and 79% vs. 63% and 58%, respectively. Both tools were accurate in predicting death ≤2, ≤3, and ≤6 months. The new score was more precise regarding death ≤1 month and survival (all time periods) and appeared preferable. However, it still needs to be validated.

Short Communication: Results of a Consensus Conference on Radiotherapy for Brain and Bone Metastases Within the Interreg-Project TreaT

“…The preferred radiotherapy regimens were similar for different age groups including elderly (65+) and very elderly (80+) patients. However, in order to provide the appropriate treatment for these patient groups, age-specific survival scores should be used for both bone and brain metastases (4)(5)(6)(7)(8).…”

“…In general, elderly and very elderly patients should not be treated with other radiotherapy regimens than patients aged <65 years. However, for optimal treatment personalization, age-specific survival scores should be used for both elderly and very elderly patients with bone or brain metastases (4)(5)(6)(7)(8). Several specific survival scores for these patient groups were developed within the Interreg-Project TreaT (5)(6)(7)(8).…”

How we treat octogenarians with brain metastases

“…The longest observed survival was 6.1 months in octogenarians managed with BSC. Given that survival after WBRT was disappointing ( 13 , 14 ), more efficacious, yet function-preserving SRS (or fractionated variants) should be considered, if KPS is ≥70 and active treatment is needed. Median survival in the literature was around 6 months.…”

“…Rades et al. reported a retrospective analysis of WBRT, the historical standard approach that is less commonly employed now, in 94 octogenarian patients ( 13 ). Their median survival was 2.0 months and the authors proposed a survival score featuring three prognostic groups based on Eastern Cooperative Oncology Group (ECOG) performance status (PS), number of lesions (single versus multiple), and extracranial metastases (present versus absent).…”

Prognostic Factors and Independent Validation of a Risk Stratification Model in Octogenarian Patients Irradiated for Brain Metastases

“…It is therefore relevant to perform separate analyses, which inform decisionmaking and result in optimized selection criteria for brain-directed radiotherapy. In addition to already validated survival prediction models, such as recursive partitioning analysis (RPA) classes, diagnosis-specific graded prognostic assessment (DS-GPA) and LabBM score (9)(10)(11)(12), which all can be recommended for clinical implementation, Rades et al suggested a new model that was derived from a dedicated study of irradiated patients aged ≥80 years (13). Their score was developed in 94 patients undergoing WBRT.…”