Outcome of Elderly Patients With Surgically Treated Brain Metastases

Overview

Journal Front Oncol

Specialty Oncology

Date 2021 Aug 12

PMID 34381733

Citations 11

Authors

Muriel Heimann

Niklas Schafer

Christian Bode

Valeri Borger

Lars Eichhorn

Frank A Giordano

Erdem Guresir

Andreas H Jacobs

Yon-Dschun Ko

Jennifer Landsberg

Felix Lehmann

Alexander Radbruch

Christina Schaub

Katjana S Schwab

Johannes Weller

Ulrich Herrlinger

Hartmut Vatter

Patrick Schuss

Matthias Schneider

Affiliations

Soon will be listed here.

Abstract

Object: In 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.

Methods: Between 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).

Results: A 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.

Conclusions: In 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.

Citing Articles

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The Role of Repeated Surgical Resections for Recurrent Brain Metastases in Older Population.

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References

Kavouridis V, Harary M, Hulsbergen A, Lo Y, Reardon D, Aizer A . Survival and prognostic factors in surgically treated brain metastases. J Neurooncol. 2019; 143(2):359-367. DOI: 10.1007/s11060-019-03171-6. View

Lagerwaard F, Levendag P, Nowak P, Eijkenboom W, Hanssens P, Schmitz P . Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys. 1999; 43(4):795-803. DOI: 10.1016/s0360-3016(98)00442-8. View

Velanovich V, Antoine H, Swartz A, Peters D, Rubinfeld I . Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res. 2013; 183(1):104-10. DOI: 10.1016/j.jss.2013.01.021. View

Hubbard R, OMahony M, Savva G, Calver B, Woodhouse K . Inflammation and frailty measures in older people. J Cell Mol Med. 2009; 13(9B):3103-9. PMC: 4516469. DOI: 10.1111/j.1582-4934.2009.00733.x. View

Hazuka M, Burleson W, Stroud D, Leonard C, Lillehei K, Kinzie J . Multiple brain metastases are associated with poor survival in patients treated with surgery and radiotherapy. J Clin Oncol. 1993; 11(2):369-73. DOI: 10.1200/JCO.1993.11.2.369. View

Handforth C, Clegg A, Young C, Simpkins S, Seymour M, Selby P . The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol. 2014; 26(6):1091-1101. DOI: 10.1093/annonc/mdu540. View

Roux A, Botella C, Still M, Zanello M, Dhermain F, Metellus P . Posterior Fossa Metastasis-Associated Obstructive Hydrocephalus in Adult Patients: Literature Review and Practical Considerations from the Neuro-Oncology Club of the French Society of Neurosurgery. World Neurosurg. 2018; 117:271-279. DOI: 10.1016/j.wneu.2018.06.084. View

Nahed B, Alvarez-Breckenridge C, Brastianos P, Shih H, Sloan A, Ammirati M . Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Surgery in the Management of Adults With Metastatic Brain Tumors. Neurosurgery. 2019; 84(3):E152-E155. DOI: 10.1093/neuros/nyy542. View

Schneider M, Potthoff A, Scharnbock E, Heimann M, Schafer N, Weller J . Newly diagnosed glioblastoma in geriatric (65 +) patients: impact of patients frailty, comorbidity burden and obesity on overall survival. J Neurooncol. 2020; 149(3):421-427. PMC: 7609438. DOI: 10.1007/s11060-020-03625-2. View

10.

Schmidt E, Balardy L, Geeraerts T, Costa N, Bowers C, Hamilton M . Editorial. Geriatric neurosurgery: the unfolding of a new subspecialty. Neurosurg Focus. 2020; 49(4):E2. DOI: 10.3171/2020.7.FOCUS20509. View

11.

Ahmed N, Mandel R, Fain M . Frailty: an emerging geriatric syndrome. Am J Med. 2007; 120(9):748-53. DOI: 10.1016/j.amjmed.2006.10.018. View

12.

Harth S, Abo-Madyan Y, Zheng L, Siebenlist K, Herskind C, Wenz F . Estimation of intracranial failure risk following hippocampal-sparing whole brain radiotherapy. Radiother Oncol. 2013; 109(1):152-8. DOI: 10.1016/j.radonc.2013.09.009. View

13.

Lapa S, Quick-Weller J, Nasari C, Dziewas R, Gessler F, Wagner M . Pre- and Post-Surgical Dysphagia in Adults with Tumors of the Posterior Fossa: A Prospective Blinded Study. Cancers (Basel). 2020; 12(9). PMC: 7564918. DOI: 10.3390/cancers12092561. View

14.

Wahl T, Graham L, Hawn M, Richman J, Hollis R, Jones C . Association of the Modified Frailty Index With 30-Day Surgical Readmission. JAMA Surg. 2017; 152(8):749-757. PMC: 5710500. DOI: 10.1001/jamasurg.2017.1025. View

15.

Chen L, Shen C, Redmond K, Page B, Kummerlowe M, McNutt T . Use of Stereotactic Radiosurgery in Elderly and Very Elderly Patients With Brain Metastases to Limit Toxicity Associated With Whole Brain Radiation Therapy. Int J Radiat Oncol Biol Phys. 2017; 98(4):939-947. DOI: 10.1016/j.ijrobp.2017.02.031. View

16.

Cesari M, Calvani R, Marzetti E . Frailty in Older Persons. Clin Geriatr Med. 2017; 33(3):293-303. DOI: 10.1016/j.cger.2017.02.002. View

17.

Soffietti R, Abacioglu U, Baumert B, Combs S, Kinhult S, Kros J . Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO). Neuro Oncol. 2017; 19(2):162-174. PMC: 5620494. DOI: 10.1093/neuonc/now241. View

18.

Schneider M, Heimann M, Schaub C, Eichhorn L, Potthoff A, Giordano F . Comorbidity Burden and Presence of Multiple Intracranial Lesions Are Associated with Adverse Events after Surgical Treatment of Patients with Brain Metastases. Cancers (Basel). 2020; 12(11). PMC: 7692304. DOI: 10.3390/cancers12113209. View

19.

Chen R, Royce T, Extermann M, Reeve B . Impact of age and comorbidity on treatment and outcomes in elderly cancer patients. Semin Radiat Oncol. 2012; 22(4):265-71. DOI: 10.1016/j.semradonc.2012.05.002. View

20.

Laino A, Woods D, Vassallo M, Qian X, Tang H, Wind-Rotolo M . Serum interleukin-6 and C-reactive protein are associated with survival in melanoma patients receiving immune checkpoint inhibition. J Immunother Cancer. 2020; 8(1). PMC: 7312339. DOI: 10.1136/jitc-2020-000842. View