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. 2021 Jan 18;11(1):123.
doi: 10.3390/brainsci11010123.

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

Martin Proescholdt  1   2 , Stephanie T Jünger  3 , Petra Schödel  1   2 , Karl-Michael Schebesch  1   2 , Christian Doenitz  1   2 , Tobias Pukrop  2   4 , Julius Höhne  1   2 , Nils-Ole Schmidt  1   2 , Martin Kocher  5 , Holger Schulz  6 , Maximilian Ruge  5 , Kevin König  3 , Roland Goldbrunner  3 , Stefan Grau  3
Affiliations

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

Martin Proescholdt et al. Brain Sci. .

Abstract

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.

Keywords: Brain metastases; elderly patients; survival; targeted therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) The postsurgical KPS was significantly better in patients receiving systemic treatment, illustrating the impact of functional status on the decision whether to apply systemic treatment or not. (b) Elderly patients with a KPS score of less than 70 who experienced functional recovery after BM resection above a KPS score of 70 showed significantly better overall survival (median OS: 10.73 vs. 5.22 months, p = 0.0001).
Figure 2
Figure 2
(a) Overall survival of the entire population (n = 807) stratified by age group (younger Table 65. years vs. 65 years and older). The elderly population shows a significantly poorer overall survival (median OS: 5.81 vs. 8.83; p = 0.0015). (b) The comparison of overall survival between patients who received systemic treatment or not applied to the entire population showed a significantly better outcome in patients receiving such treatment (median OS: 15.38 vs. 6.99 months, p = 0.00001). (c) The identical comparison applied to the elderly population confirmed the effects of systemic effect on overall survival (median OS: 10.33 vs. 3.87 months, p = 0.0001). (d) When analyzing only patients who received systemic treatment, no significant impact of age group was detectable anymore (p = 0.927).
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