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Stereotactic radiosurgery in elderly patients with brain metastases: comparison with non-elderly patients using database of a multi-institutional prospective observational study (JLGK0901-Elderly).
Higuchi, Yoshinori; Yamamoto, Masaaki; Serizawa, Toru; Sato, Yasunori; Shuto, Takashi; Akabane, Atsuya; Jokura, Hidefumi; Yomo, Shoji; Nagano, Osamu; Kawagishi, Jun; Yamanaka, Kazuhiro; Aoyama, Hidefumi.
Afiliação
  • Higuchi Y; Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
  • Yamamoto M; Katsuta Hospital Mito GammaHouse, Nakane 5125-2, Hitachinaka, Ibaraki, 312-0011, Japan. bcd06275@nifty.com.
  • Serizawa T; Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan.
  • Sato Y; Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.
  • Shuto T; Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Japan.
  • Akabane A; Gamma Knife Center, NTT Medical Center Tokyo, Tokyo, Japan.
  • Jokura H; Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Japan.
  • Yomo S; Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Japan.
  • Nagano O; Gamma Knife House, Chiba Cerebral and Cardiovascular Center, Ichihara, Japan.
  • Kawagishi J; Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Japan.
  • Yamanaka K; Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
  • Aoyama H; Department of Radiology, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan.
J Neurooncol ; 144(2): 393-402, 2019 Sep.
Article em En | MEDLINE | ID: mdl-31338786
ABSTRACT

PURPOSE:

Stereotactic radiosurgery (SRS) has been increasingly used for elderly patients with brain metastases (BMs). However, no studies based on a large sample size have been reported. To compare SRS treatment results between elderly and non-elderly patients, we performed a subset study of elderly patients using our prospectively-accumulated multi-institution study database (JLGK0901 Study, Lancet Oncol 15387-395, 2014).

METHODS:

During the 2009-2011 period, 1194 eligible patients undergoing gamma knife SRS alone for newly diagnosed BMs were enrolled in this study from 23 gamma knife facilities in Japan. Observation was discontinued at the end of 2013. The 1194 patients were divided into the two age groups, 693 elderly ( ≥ 65 years) and 501 non-elderly ( < 65 years) patients. Our study protocol neither set an upper age limit nor required dose de-escalation.

RESULTS:

Median post-SRS survival time was significantly shorter in the elderly than in the non-elderly patient group (10.3 vs 14.3 months, HR 1.380, 95% CI 1.218-1.563, p < 0.0001). However, regarding all secondary endpoints including neurological death, neurological deterioration, SRS-related complications, leukoencephalopathy, local recurrence, newly-developed tumors, meningeal dissemination, salvage SRS, whole brain radiotherapy and surgery and decreased mini-mental state examination scores, the elderly patient group was not inferior to the non-elderly patient group. In the 693 elderly patients, there was no post-SRS median survival time difference between those with 5-10 versus 2-4 tumors (10.8 vs 8.9 months, HR 0.936, 95% CI 0.744-1.167, p = 0.5601).

CONCLUSIONS:

We conclude that elderly BM patients are not unfavorable candidates for SRS alone treatment.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias Encefálicas / Radiocirurgia / Neoplasias Tipo de estudo: Clinical_trials / Guideline / Observational_studies / Prognostic_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Neurooncol Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Japão

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias Encefálicas / Radiocirurgia / Neoplasias Tipo de estudo: Clinical_trials / Guideline / Observational_studies / Prognostic_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Neurooncol Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Japão