Brain metastases in the elderly – Impact of residual tumor volume on overall survival

• DOI: 10.3389/fonc.2023.1149628
• Publication Date: 2023-04-04T17:39:10Z
• Authors: Lea Baumgart; Amir Kaywan Aftahy; Aida Anetsberger; Dennis Thunstedt; Benedikt Wiestler; Denise Bernhardt; Stephanie E. Combs; Bernhard Meyer; Hanno S. Meyer; Jens Gempt
• Keywords: Univariate analysis; Brain tumor; Performance status

Due to demographic changes and an increased incidence of cancer with age, the number patients brain metastases (BMs) constantly increases, especially among elderly. Novel systemic therapies, such as immunotherapy, have led improved survival in recent years, but intracranial tumor progression may occur independently a systemically effective therapy. Despite growing geriatric patients, they are often overlooked clinical trials, there is no consensus on impact BM resection survival.The aim this study was analyze residual volume outcome overall (OS) elderly suffering from BM.Patients ≥ 75 years who had surgery for between April 2007 January 2020 were retrospectively included. Residual burden (RTB) determined by segmentation early postoperative MRI (72 h). Contrast-enhancing subvolumes segmented manually. "Postoperative volume" refers targeted BMs. Impact preoperative Karnofsky performance status scale (KPSS), sex RTB OS analyzed. Survival analyses performed using Kaplan-Meier estimates univariate analysis Cox regression proportional hazards model multivariate analysis.One hundred one Median age at 78 (IQR 76-81). Sixty-two (61%) single BM; 16 (16%) two BMs; 13 (13%) three 10 (10%) more than 10.3 cm3 5-25 cm3), 0 0-1.1 cm3). Complete cytoreduction (RTB = 0) achieved 52 (52%). (78%). 7 months 2-11). In analysis, high KPSS (HR 0.986, 95% CI 0.973-0.998, p 0.026) small 1.025, 1.002-1.047, 0.029) significantly associated prolonged OS. Patients survived longer those did (12 [IQR 5-19] vs. 5 3-7] months, 0.007). Furthermore, prolongation favorable KPSS, adjusted HR 0.986 (p 0.026). However, significances regarding age.RTB strong predictor OS, regardless or type. Postoperative should confirm extent resection, intraoperative do not warrant complete resection. It crucial maximal achieve best long-term outcomes these despite fact advanced age.