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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Symptomatic brain metastases in the elderly population – the risk and benefit of surgery in the context of systemic oncological treatment

Symptomatische Hirnmetastasen bei alten Patienten – Nutzen und Risiko der Neurochirurgie im Kontext onkologischer Systemtherapie

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  • presenting/speaker Stephanie T. Jünger - Universitätsklinikum Köln, Neurochirurgie, Köln, Deutschland
  • Petra Schödel - Universitätsklinikum Regensburg, Neurochirurgie, Regensburg, Deutschland
  • Martin Proescholdt - Universitätsklinikum Regensburg, Neurochirurgie, Regensburg, Deutschland
  • Stefan Grau - Universitätsklinikum Köln, Neurochirurgie, Köln, Deutschland
  • Karl-Michael Schebesch - Universitätsklinikum Regensburg, Neurochirurgie, Regensburg, Deutschland
  • Christian Doenitz - Universitätsklinikum Regensburg, Neurochirurgie, Regensburg, Deutschland
  • Lukasz Rams - Universitätsklinikum Regensburg, Neurochirurgie, Regensburg, Deutschland
  • Alexander Brawanski - Universitätsklinikum Regensburg, Neurochirurgie, Regensburg, Deutschland
  • Martin Kocher - Universitätsklinikum Köln, Stereotaxie, Köln, Deutschland
  • Holger Schulz - Praxis internistischer Onkologie und Hämatologie, Onkologie und Hämatologie, Frechen, Deutschland
  • Kevin König - Universitätsklinikum Köln, Neurochirurgie, Köln, Deutschland
  • Roland H. Goldbrunner - Universitätsklinikum Köln, Neurochirurgie, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV286

doi: 10.3205/20dgnc282, urn:nbn:de:0183-20dgnc2822

Published: June 26, 2020

© 2020 Jünger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: For patients with brain metastases (BM) advanced age is considered a negative prognostic factor, especially since general condition frequently limited systemic treatment options. Due to lower toxicity, novel molecular agents comprise a suitable alternative for these patients. Therefore, we analyzed the postoperative clinical course of elderly patients operated on symptomatic BM in this context.

Methods: We retrospectively analyzed patients receiving resection of mostly symptomatic BM at two institutions between 2012 and 2018. Primary tumor, number of lesions, pre- and postoperative KPS, co-morbidity and postoperative treatment were analyzed. Post-treatment survival was calculated using Kaplan-Meyer analysis. Prognostic factors were identified using multivariate Cox-regression.

Results: We included 313 patients aged at least 65 years (group A) and compared them to 493 patients below 65 years (group B). Primary tumor, systemic status and number of metastases did not differ significantly between the groups. Surgical complication rate was similar in both groups and clinical status significantly improved despite patients age (p=0.0001).

Induction of systemic treatment was administered less frequently to elderly patients (p=0.000), induction of such therapies correlated with the clinical status (p = 0.037) though. Median survival after resection of BM differed significantly between groups (p = 0.0049), however, survival curves separated only in the long-term course. Postoperative systemic treatment increased further survival significantly in both groups (p = 0.00001). Considering those patients who received systemic treatment, age itself was no longer a negative prognostic factor (p = 0.865). In the multivariate regression analysis, clinical status and systemic treatment remained the strongest predictors for survival (p = 0.0001).

Conclusion: Resection reduces neurological deficits in patients with brain metastasis, disregarding age, and leads to a higher frequency of systemic treatment induction, which in turn increases further survival.