Randolph David M, McTyre Emory, Klepin Heidi, Peiffer Ann M, Ayala-Peacock Diandra, Lester Scott, Laxton Adrian W, Dohm Ammoren, Tatter Stephen B, Shaw Edward G, Chan Michael D
Department of Radiation Oncology, Wake Forest University, Winston-Salem, NC 27157, USA.
Department of Medical Oncology, Wake Forest University, Winston-Salem, NC 27157, USA.
J Radiosurg SBRT. 2017;5(1):35-42.
Recent trials have shown that whole brain radiotherapy (WBRT) can worsen performance status, particularly in the geriatric population. We reviewed our institutional experience with geriatric patients (> 70 years) with brain metastases treated with radiosurgery (SRS) to determine clinical and quality of life (QOL) outcomes.
Between 7/2000 and 1/2013, a retrospective review was performed on 467 patients treated with SRS (114 geriatric patients). Overall survival (OS), cause of death, and WBRT were evaluated. A retrospective review of geriatric patients was performed with assessments of Karnofsky performance score (KPS, N=69), mini-mental status examinations (MMSE, N=39), and Spitzer QOL (SQOL, N=39) at initial interview, 6, and 12 months after SRS. Repeated Measures ANOVA was used to evaluate differences in quality of life values. Kaplan-Meier analysis estimated survival and time to WBRT.
Geriatric patients had a shorter OS compared to non-geriatric patients (p<0.035). Fewer patients in the geriatric cohort received whole brain (p<0.001) or subsequent Gamma Knife stereotactic radiosurgery (GKRS) (p<0.025). No difference was seen in neurologic death rates (p<0.4). In geriatric patients, SQOL declined from 0 to 6 months (mean 6.5 to 5.9, respectively, p<0.02) and 0 to 12 months (mean 6.5 and 5.6, respectively, p<0.03). KPS and MMSE scores did not change over time. Grade 3 or 4 toxicity was 9% in geriatric patients. There was no grade 5 toxicity.
Geriatric patients tolerate GKRS without a significant decline in KPS or MMSE and with acceptable toxicity profile. SRS also spares a significant proportion of geriatric patients from WBRT, and its associated toxicities.
近期试验表明，全脑放疗（WBRT）会使身体状况恶化，尤其是在老年人群中。我们回顾了我院对接受放射外科治疗（SRS）的老年脑转移瘤患者（年龄>70岁）的治疗经验，以确定临床和生活质量（QOL）结果。
在2000年7月至2013年1月期间，对467例接受SRS治疗的患者（114例老年患者）进行了回顾性研究。评估总生存期（OS）、死亡原因和WBRT情况。对老年患者进行回顾性研究，在初次就诊时、SRS后6个月和12个月对卡诺夫斯基表现评分（KPS，N = 69）、简易精神状态检查（MMSE，N = 39）和斯皮策生活质量量表（SQOL，N = 39）进行评估。采用重复测量方差分析来评估生活质量值的差异。采用Kaplan-Meier分析估计生存期和至WBRT的时间。
与非老年患者相比，老年患者的OS较短（p<0.035）。老年队列中接受全脑放疗（p<0.001）或后续伽玛刀立体定向放射外科治疗（GKRS）（p<0.025）的患者较少。神经源性死亡率未见差异（p<0.4）。在老年患者中，SQOL从0至6个月下降（分别从平均6.5降至5.9，p<0.02）以及从0至12个月下降（分别从平均6.5降至5.6，p<0.03）。KPS和MMSE评分随时间未发生变化。老年患者3级或4级毒性反应为9%。无5级毒性反应。
老年患者能够耐受GKRS，KPS或MMSE无显著下降，且毒性反应可接受。SRS还使很大一部分老年患者免于接受WBRT及其相关毒性反应。
