Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Katsuta Hospital Mito GammaHouse, Nakane 5125-2, Hitachinaka, Ibaraki, 312-0011, Japan.
J Neurooncol. 2019 Sep;144(2):393-402. doi: 10.1007/s11060-019-03242-8. Epub 2019 Jul 23.
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 15:387-395, 2014).
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.
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).
We conclude that elderly BM patients are not unfavorable candidates for SRS alone treatment.
立体定向放射外科（SRS）已越来越多地用于治疗脑转移瘤（BM）的老年患者。然而，目前尚无基于大样本量的研究报道。为了比较老年患者与非老年患者的 SRS 治疗效果，我们使用前瞻性积累的多机构研究数据库（JLGK0901 研究，Lancet Oncol 15：387-395，2014）对老年患者进行了亚组研究。
在 2009-2011 年期间，从日本 23 家伽玛刀中心共招募了 1194 例接受伽玛刀 SRS 单独治疗新诊断的 BM 患者入组本研究。观察于 2013 年底结束。将 1194 例患者分为 2 个年龄组，693 例老年（≥65 岁）和 501 例非老年（<65 岁）患者。我们的研究方案既没有设定上限年龄，也没有要求剂量降低。
SRS 后中位生存时间在老年患者明显短于非老年患者（10.3 与 14.3 个月，HR 1.380，95%CI 1.218-1.563，p<0.0001）。然而，在所有次要终点方面，包括神经死亡、神经恶化、SRS 相关并发症、脑白质病、局部复发、新发肿瘤、脑膜播散、挽救性 SRS、全脑放疗和手术以及简易精神状态检查评分降低，老年患者组并不逊于非老年患者组。在 693 例老年患者中，5-10 个与 2-4 个肿瘤的 SRS 后中位生存时间无差异（10.8 与 8.9 个月，HR 0.936，95%CI 0.744-1.167，p=0.5601）。
我们的结论是，老年 BM 患者不是 SRS 单独治疗的不利候选者。
