Cancer Res Treat.  2025 Jan;57(1):47-56. 10.4143/crt.2024.223.

Upfront Stereotactic Radiosurgery or Fractionated Stereotactic Radiotherapy in Elderly Patients with Brain Metastases from Non–Small Cell Lung Cancer: A Retrospective Analysis of a 10-Year Bi-institutional Experience

• Kim M
• Cha J
• Kim HJ
• Kim WC
• Lee J

• KMID: 2564580
• DOI: http://doi.org/10.4143/crt.2024.223

Abstract

Purpose
Stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) are increasingly used as initial therapies for brain metastases (BM). We aimed to assess the outcomes of SRS/FSRT in patients aged ≥ 65 years who had 1-10 BM from non–small cell lung cancer (NSCLC).
Materials and Methods
We retrospectively reviewed 91 elderly NSCLC patients with 222 BM who were treated with SRS/FSRT at two institutions between 2010 and 2020. The primary endpoint was overall survival (OS) after SRS/FSRT. In addition, in-field local control (IFLC) within the treated field was evaluated. Statistical analysis was performed to identify the prognostic factors affecting OS and IFLC.
Results
During a median follow-up of 18 months, the median OS was 32 months. The 1- and 2-year survival rates were 69.8% and 56.1%, respectively. In multivariate analysis, the NSCLC-specific graded prognostic assessment (GPA) score (p=0.007) and administration of systemic therapy (p=0.039) were defined as prognosticators affecting OS. The median IFLC period was 31 months, and the 1- and 2-year IFLC rates were 75.9% and 57.6%, respectively. The total BM volume (p=0.042) significantly affected IFLC. No severe adverse events were reported after SRS/FSRT.
Conclusion
SRS/FSRT is an effective upfront treatment option for BM arising from NSCLC in elderly patients, with a good OS without severe side effects. Higher GPA score and active systemic treatment were associated with improved OS, indicating that elderly patients are significant candidates for SRS/FSRT.

Keyword

Brain neoplasms; Non-small cell lung carcinoma; Radiosurgery; Treatment outcomes

Figure

• 

  Fig. 1. Radiation therapy plans for both non–small cell lung cancer patients with a single brain metastasis (BM) who received < 15 Gy by a single fraction (biological equivalent dose, 37.5 Gy). For one patient, a stereotactic radiosurgery (SRS) of 12 Gy was administered because the BM was located in the pons (A). Another patient received an SRS of 13 Gy due to the BM being located close to the brain stem and inner ear (B).

• 

  Fig. 2. Overall survival following stereotactic radiosurgery (SRS)/fractionated stereo tactic radiotherapy (FSRT) for brain metastasis (BM) in the cohort (A), according to the non–small cell lung cancer–specific graded prognostic assessment (GPA) score (B), number of BM (C), and administration of systemic chemotherapy (D). CTx, chemotherapy.

• 

  Fig. 3. In-field local control of brain metastasis (BM) treated with stereotactic radiosurgery (SRS)/fractionated stereo tactic radiotherapy (FSRT) in the cohort (A), according to the total volume of BM (B), number of BM (C), and biologically effective dose (BED) (D).

Reference

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