Stereotactic Radiosurgery Appears to Benefit Both Older and Younger Patients With Brain Metastases

By Will Boggs, MD

September 21, 2020

NEW YORK (Reuters Health) - Stereotactic radiosurgery (SRS) provides similar overall survival in patients older and younger than 75 years who have brain metastases from lung cancer, according to a retrospective study from Japan.

SRS is commonly recommended for lung-cancer patients with brain metastases who are undergoing curative treatment, but little is known about the outcomes in patients 75 years and older.

Dr. Masaaki Yamamoto of Katsuta Hospital Mito GammaHouse, in Hitachi-naka, and Tokyo Women's Medical University and colleagues used data from 2,915 patients aged 65 years and older with primary lung tumors who underwent SRS for brain metastases to compare outcomes between those aged 65-74 years and those aged 75 years or older.

Median survival after SRS was 9.0 months in patients with non-small-cell lung cancer (NSCLC) and 7.2 months in patients with small-cell lung cancer (SCLC).

Among patients with NSCLC, post-SRS median survival time was significantly shorter in the older age group (75 years and older, 9.0 months) than in the younger age group (65-74 years old, 10.2 months).

In contrast, post-SRS median survival time in the SCLC group did not differ significantly between older (7.2 months) and younger (8.7 months) patients, the researchers report in Lung Cancer.

In the NSCLC patient group, the incidences of neurological death, neurological deterioration, local recurrence, repeat SRS and salvage whole-brain radiotherapy (WBRT) were significantly lower in the older group. In the SCLC patient group, only the incidence of salvage WBRT was significantly lower in the older group.

"Our results suggest that carefully-selected patients 75 years of age or older are not poor candidates for SRS as compared to those 65-74 years old," the authors conclude.

Dr. Jason P. Sheehan of the University of Virginia, in Charlottesville, who has studied SRS for brain metastases, told Reuters Health by email, "Based upon this study and others published in the literature, it would appear that elderly and non-elderly patients with brain metastasis from lung cancer can have favorable responses to SRS."

"The current study clearly demonstrates the therapeutic value of SRS in brain metastasis patients and strongly indicates that older age should not be an exclusion factor for SRS," concluded Dr. Sheehan, who was not involved in the study.

Dr. Yamamoto did not respond to a request for comments.

SOURCE: Lung Cancer, online August 17, 2020.