Cargando…
Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival
BACKGROUND: Gamma knife radiosurgery (GKRS) has been increasingly employed for the treatment of elderly patients with brain metastases, mainly due to its demonstrated effectiveness and low complication rate. However, only a few studies have investigated the prognostic factors that influence the surv...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4333254/ https://www.ncbi.nlm.nih.gov/pubmed/25885321 http://dx.doi.org/10.1186/s12885-015-1070-y |
_version_ | 1782358003237781504 |
---|---|
author | Park, Jae-Young Moon, Kyung-Sub Lee, Kyung-Hwa Lim, Sa-Hoe Jang, Woo-Youl Lee, Hyeseon Jung, Tae-Young Kim, In-Young Jung, Shin |
author_facet | Park, Jae-Young Moon, Kyung-Sub Lee, Kyung-Hwa Lim, Sa-Hoe Jang, Woo-Youl Lee, Hyeseon Jung, Tae-Young Kim, In-Young Jung, Shin |
author_sort | Park, Jae-Young |
collection | PubMed |
description | BACKGROUND: Gamma knife radiosurgery (GKRS) has been increasingly employed for the treatment of elderly patients with brain metastases, mainly due to its demonstrated effectiveness and low complication rate. However, only a few studies have investigated the prognostic factors that influence the survival of elderly patients after GKRS. The purpose of this study was to identify a scoring system that is able to predict the survival of elderly patients undergoing GKRS using data obtained at the time of diagnosis for brain metastases. METHODS: Between 2004 and 2011, death was confirmed in 147 patients aged 70 years and older who had been treated with GKRS for brain metastases. Median age at the time of GKRS was 75.7 years (range, 70–86 years). The median tumor volume was 5.1 cm(3) (range, 0.05–59.9 cm(3)). The median marginal prescription dose was 21.4 Gy (range, 14–25 Gy). RESULTS: The median survival was 167 days. Overall survival rates at 6 months and 1 year were 60.4% and 29.4%, respectively. Among the patient characteristics pertaining to systemic cancer and brain metastasis for which data were obtained preoperatively, a multivariate analysis showed that low Karnofsky performance status (KPS ≤ 80, P = 0.047) and the presence of extracranial metastases (P = 0.014) detected at the time of brain metastasis diagnosis were independent prognostic factors for short survival. A high score index for radiosurgery (SIR score ≥ 4, P = 0.024) and a high graded prognostic assessment (GPA score ≥ 2, P = 0.004) were associated with longer survival. A multivariate analysis of the important characteristics of systemic cancer, and the scoring system evaluating survival duration showed that a low GPA score was the most powerful independent factor for predicting short survival (hazard ratio 1.756, 95% confidence interval 1.252–2.456, P = 0.001). CONCLUSIONS: GKRS is a safe approach to treat brain metastases in patients age 70 years and older. In this group, our study identified GPA score at the time of GKRS as a powerful prognostic factor for survival. |
format | Online Article Text |
id | pubmed-4333254 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-43332542015-02-20 Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival Park, Jae-Young Moon, Kyung-Sub Lee, Kyung-Hwa Lim, Sa-Hoe Jang, Woo-Youl Lee, Hyeseon Jung, Tae-Young Kim, In-Young Jung, Shin BMC Cancer Research Article BACKGROUND: Gamma knife radiosurgery (GKRS) has been increasingly employed for the treatment of elderly patients with brain metastases, mainly due to its demonstrated effectiveness and low complication rate. However, only a few studies have investigated the prognostic factors that influence the survival of elderly patients after GKRS. The purpose of this study was to identify a scoring system that is able to predict the survival of elderly patients undergoing GKRS using data obtained at the time of diagnosis for brain metastases. METHODS: Between 2004 and 2011, death was confirmed in 147 patients aged 70 years and older who had been treated with GKRS for brain metastases. Median age at the time of GKRS was 75.7 years (range, 70–86 years). The median tumor volume was 5.1 cm(3) (range, 0.05–59.9 cm(3)). The median marginal prescription dose was 21.4 Gy (range, 14–25 Gy). RESULTS: The median survival was 167 days. Overall survival rates at 6 months and 1 year were 60.4% and 29.4%, respectively. Among the patient characteristics pertaining to systemic cancer and brain metastasis for which data were obtained preoperatively, a multivariate analysis showed that low Karnofsky performance status (KPS ≤ 80, P = 0.047) and the presence of extracranial metastases (P = 0.014) detected at the time of brain metastasis diagnosis were independent prognostic factors for short survival. A high score index for radiosurgery (SIR score ≥ 4, P = 0.024) and a high graded prognostic assessment (GPA score ≥ 2, P = 0.004) were associated with longer survival. A multivariate analysis of the important characteristics of systemic cancer, and the scoring system evaluating survival duration showed that a low GPA score was the most powerful independent factor for predicting short survival (hazard ratio 1.756, 95% confidence interval 1.252–2.456, P = 0.001). CONCLUSIONS: GKRS is a safe approach to treat brain metastases in patients age 70 years and older. In this group, our study identified GPA score at the time of GKRS as a powerful prognostic factor for survival. BioMed Central 2015-02-14 /pmc/articles/PMC4333254/ /pubmed/25885321 http://dx.doi.org/10.1186/s12885-015-1070-y Text en © Park et al.; licensee BioMed Central. 2015 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Park, Jae-Young Moon, Kyung-Sub Lee, Kyung-Hwa Lim, Sa-Hoe Jang, Woo-Youl Lee, Hyeseon Jung, Tae-Young Kim, In-Young Jung, Shin Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival |
title | Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival |
title_full | Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival |
title_fullStr | Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival |
title_full_unstemmed | Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival |
title_short | Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival |
title_sort | gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4333254/ https://www.ncbi.nlm.nih.gov/pubmed/25885321 http://dx.doi.org/10.1186/s12885-015-1070-y |
work_keys_str_mv | AT parkjaeyoung gammakniferadiosurgeryforelderlypatientswithbrainmetastasesevaluationofscoringsystemsthatpredictsurvival AT moonkyungsub gammakniferadiosurgeryforelderlypatientswithbrainmetastasesevaluationofscoringsystemsthatpredictsurvival AT leekyunghwa gammakniferadiosurgeryforelderlypatientswithbrainmetastasesevaluationofscoringsystemsthatpredictsurvival AT limsahoe gammakniferadiosurgeryforelderlypatientswithbrainmetastasesevaluationofscoringsystemsthatpredictsurvival AT jangwooyoul gammakniferadiosurgeryforelderlypatientswithbrainmetastasesevaluationofscoringsystemsthatpredictsurvival AT leehyeseon gammakniferadiosurgeryforelderlypatientswithbrainmetastasesevaluationofscoringsystemsthatpredictsurvival AT jungtaeyoung gammakniferadiosurgeryforelderlypatientswithbrainmetastasesevaluationofscoringsystemsthatpredictsurvival AT kiminyoung gammakniferadiosurgeryforelderlypatientswithbrainmetastasesevaluationofscoringsystemsthatpredictsurvival AT jungshin gammakniferadiosurgeryforelderlypatientswithbrainmetastasesevaluationofscoringsystemsthatpredictsurvival |