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Brain Metastases in Elderly Patients—The Role of Surgery in the Context of Systemic Treatment

In patients with brain metastases (BM), advanced age is considered a negative prognostic factor. To address the potential reasons for that, we assessed 807 patients who had undergone BM resection; 315 patients aged at least 65 years (group A) were compared with 492 younger patients (group B). We ana...

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Autores principales: Proescholdt, Martin, Jünger, Stephanie T., Schödel, Petra, Schebesch, Karl-Michael, Doenitz, Christian, Pukrop, Tobias, Höhne, Julius, Schmidt, Nils-Ole, Kocher, Martin, Schulz, Holger, Ruge, Maximilian, König, Kevin, Goldbrunner, Roland, Grau, Stefan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831306/
https://www.ncbi.nlm.nih.gov/pubmed/33477588
http://dx.doi.org/10.3390/brainsci11010123
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author Proescholdt, Martin
Jünger, Stephanie T.
Schödel, Petra
Schebesch, Karl-Michael
Doenitz, Christian
Pukrop, Tobias
Höhne, Julius
Schmidt, Nils-Ole
Kocher, Martin
Schulz, Holger
Ruge, Maximilian
König, Kevin
Goldbrunner, Roland
Grau, Stefan
author_facet Proescholdt, Martin
Jünger, Stephanie T.
Schödel, Petra
Schebesch, Karl-Michael
Doenitz, Christian
Pukrop, Tobias
Höhne, Julius
Schmidt, Nils-Ole
Kocher, Martin
Schulz, Holger
Ruge, Maximilian
König, Kevin
Goldbrunner, Roland
Grau, Stefan
author_sort Proescholdt, Martin
collection PubMed
description In patients with brain metastases (BM), advanced age is considered a negative prognostic factor. To address the potential reasons for that, we assessed 807 patients who had undergone BM resection; 315 patients aged at least 65 years (group A) were compared with 492 younger patients (group B). We analyzed the impact of the pre- and postoperative Karnofsky performance status (KPS), postoperative treatment structure and post-treatment survival. BM resection significantly improved KPS scores in both groups (p = 0.0001). Median survival after BM resection differed significantly between the groups (A: 5.81 vs. B: 8.12 months; p = 0.0015). In both groups, patients who received postoperative systemic treatment showed significantly longer overall survival (p = 0.00001). However, elderly patients less frequently received systemic treatment (p = 0.0001) and the subgroup of elderly patients receiving such therapies had a significantly higher postsurgical KPS score (p = 0.0007). In all patients receiving systemic treatment, age was no longer a negative prognostic factor. Resection of BM improves the functional status of elderly patients, thus enhancing the likeliness to receive systemic treatment, which, in turn, leads to longer overall survival. In the context of such a treatment structure, age alone is no longer a prognostic factor for survival.
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spelling pubmed-78313062021-01-26 Brain Metastases in Elderly Patients—The Role of Surgery in the Context of Systemic Treatment Proescholdt, Martin Jünger, Stephanie T. Schödel, Petra Schebesch, Karl-Michael Doenitz, Christian Pukrop, Tobias Höhne, Julius Schmidt, Nils-Ole Kocher, Martin Schulz, Holger Ruge, Maximilian König, Kevin Goldbrunner, Roland Grau, Stefan Brain Sci Article In patients with brain metastases (BM), advanced age is considered a negative prognostic factor. To address the potential reasons for that, we assessed 807 patients who had undergone BM resection; 315 patients aged at least 65 years (group A) were compared with 492 younger patients (group B). We analyzed the impact of the pre- and postoperative Karnofsky performance status (KPS), postoperative treatment structure and post-treatment survival. BM resection significantly improved KPS scores in both groups (p = 0.0001). Median survival after BM resection differed significantly between the groups (A: 5.81 vs. B: 8.12 months; p = 0.0015). In both groups, patients who received postoperative systemic treatment showed significantly longer overall survival (p = 0.00001). However, elderly patients less frequently received systemic treatment (p = 0.0001) and the subgroup of elderly patients receiving such therapies had a significantly higher postsurgical KPS score (p = 0.0007). In all patients receiving systemic treatment, age was no longer a negative prognostic factor. Resection of BM improves the functional status of elderly patients, thus enhancing the likeliness to receive systemic treatment, which, in turn, leads to longer overall survival. In the context of such a treatment structure, age alone is no longer a prognostic factor for survival. MDPI 2021-01-18 /pmc/articles/PMC7831306/ /pubmed/33477588 http://dx.doi.org/10.3390/brainsci11010123 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Proescholdt, Martin
Jünger, Stephanie T.
Schödel, Petra
Schebesch, Karl-Michael
Doenitz, Christian
Pukrop, Tobias
Höhne, Julius
Schmidt, Nils-Ole
Kocher, Martin
Schulz, Holger
Ruge, Maximilian
König, Kevin
Goldbrunner, Roland
Grau, Stefan
Brain Metastases in Elderly Patients—The Role of Surgery in the Context of Systemic Treatment
title Brain Metastases in Elderly Patients—The Role of Surgery in the Context of Systemic Treatment
title_full Brain Metastases in Elderly Patients—The Role of Surgery in the Context of Systemic Treatment
title_fullStr Brain Metastases in Elderly Patients—The Role of Surgery in the Context of Systemic Treatment
title_full_unstemmed Brain Metastases in Elderly Patients—The Role of Surgery in the Context of Systemic Treatment
title_short Brain Metastases in Elderly Patients—The Role of Surgery in the Context of Systemic Treatment
title_sort brain metastases in elderly patients—the role of surgery in the context of systemic treatment
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831306/
https://www.ncbi.nlm.nih.gov/pubmed/33477588
http://dx.doi.org/10.3390/brainsci11010123
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