Frailty, a state of increased vulnerability to adverse health outcomes, is associated with poor neurosurgical outcomes. The relationship between frailty and stereotactic radiosurgery (SRS) for brain metastases (BMs), however, has not been adequately described. In this study, the authors attempted to examine the connection between frailty and outcomes for patients receiving SRS for BMs.
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A single-center retrospective cohort study was performed. The 5-factor modified frailty index (mFI-5) was used to stratify patients into pre-frail (mFI-5 score 0–1), frail (mFI-5 score 2), and severely frail (mFI-5 score ≥ 3) cohorts at the time of SRS treatment. Both overall survival (OS) and progression-free survival (PFS) were evaluated. Factors associated with OS/PFS were assessed using Kaplan-Meier analysis and a Cox proportional hazards model.
RESULTS
Two hundred three patients met the inclusion criteria and received SRS to one or more BMs. Fifty-six patients (27.6%) received SRS as an adjuvant treatment. The 12-month OS and PFS rates were 58.6% and 45.5%, respectively. One hundred twenty-six patients (62.1%) were classified as pre-frail, 58 (28.6%) as frail, and 19 (9.4%) as severely frail. Significantly less OS was demonstrated in frailer groups (frail hazard ratio [HR] 3.14, p < 0.005; severely frail HR 3.13, p < 0.005). Compared with pre-frail patients, frail patients had shorter intervals of PFS (frail HR 2.05, p < 0.005). Five patients (2.5%) had symptomatic radiation necrosis (RN) and 60 (29.6%) required repeat radiation.
CONCLUSIONS
Higher frailty scores at the time of SRS treatment were predictive of shorter OS and PFS intervals.
Barnholtz-SloanJS,SloanAE,DavisFG,VigneauFD,laiP,SawayaRE.Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System.J Clin Oncol.2004;22(14):2865–2872.
Barnholtz-Sloan
JS
,
Sloan
AE
,
Davis
FG
,
Vigneau
FD
,
lai
P
,
Sawaya
RE
.
Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System
.J Clin Oncol
.
2004
;
22
(
14
):
2865
–
2872
.)| false
SchoutenlJ,RuttenJ,HuveneersHA,TwijnstraA.Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma.Cancer.2002;94(10):2698–2705.
Schouten
lJ
,
Rutten
J
,
Huveneers
HA
,
Twijnstra
A
.
Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma
.Cancer
.
2002
;
94
(
10
):
2698
–
2705
.)| false
Suh
JH
,
Kotecha
R
,
Chao
ST
,
Ahluwalia
MS
,
Sahgal
A
,
Chang
EL
.
Current approaches to the management of brain metastases
.Nat Rev Clin Oncol
.
2020
;
17
(
5
):
279
–
299
.)| false
MrduttMM,PapaconstantinouHT,RobinsonBD,BirdET,IsbellCL.Preoperative frailty and surgical outcomes across diverse surgical subspecialties in a large health care system.J Am Coll Surg.2019;228(4):482–490.
Mrdutt
MM
,
Papaconstantinou
HT
,
Robinson
BD
,
Bird
ET
,
Isbell
CL
.
Preoperative frailty and surgical outcomes across diverse surgical subspecialties in a large health care system
.J Am Coll Surg
.
2019
;
228
(
4
):
482
–
490
.)| false
YoungermanBE,NeugutAI,YangJ,HershmanDL,WrightJD,BruceJN.The modified frailty index and 30-day adverse events in oncologic neurosurgery.J Neurooncol.2018;136(1):197–206.
KhalafallahAM,HuqS,JimenezAE,BremH,MukherjeeD.The 5-factor modified frailty index: an effective predictor of mortality in brain tumor patients.J Neurosurg.2020;135(1):78–86.
DicpinigaitisAJ,HanftS,CooperJB,et al.Comparative associations of baseline frailty status and age with postoperative mortality and duration of hospital stay following metastatic brain tumor resection.Clin Exp Metastasis.2022;39(2):303–310.
Dicpinigaitis
AJ
,
Hanft
S
,
Cooper
JB
,
Comparative associations of baseline frailty status and age with postoperative mortality and duration of hospital stay following metastatic brain tumor resection
.Clin Exp Metastasis
.
2022
;
39
(
2
):
303
–
310
.)| false
ColeKL,KazimSF,ThommenR,et al.Association of baseline frailty status and age with outcomes in patients undergoing intracranial meningioma surgery: results of a nationwide analysis of 5818 patients from the National Surgical Quality Improvement Program (NSQIP) 2015-2019.Eur J Surg Oncol.2022;48(7):1671–1677.
Cole
KL
,
Kazim
SF
,
Thommen
R
,
Association of baseline frailty status and age with outcomes in patients undergoing intracranial meningioma surgery: results of a nationwide analysis of 5818 patients from the National Surgical Quality Improvement Program (NSQIP) 2015-2019
.Eur J Surg Oncol
.
2022
;
48
(
7
):
1671
–
1677
.)| false
lin
NU
,
李
EQ
,
Aoyama
H
,
Response assessment criteria for brain metastases: proposal from the RANO group
.lancet Oncol
.
2015
;
16
(
6
):
e270
–
e278
.)| false
ChaoST,AhluwaliaMS,BarnettGH,et al.Challenges with the diagnosis and treatment of cerebral radiation necrosis.Int J Radiat Oncol Biol Phys.2013;87(3):449–457.
MillerJA,BennettEE,XiaoR,et al.Association between radiation necrosis and tumor biology after stereotactic radiosurgery for brain metastasis.Int J Radiat Oncol Biol Phys.2016;96(5):1060–1069.
Miller
JA
,
Bennett
EE
,
Xiao
R
,
Association between radiation necrosis and tumor biology after stereotactic radiosurgery for brain metastasis
.Int J Radiat Oncol Biol Phys
.
2016
;
96
(
5
):
1060
–
1069
.)| false
le RhunE,DevosP,BoulangerT,et al.The RANO Leptomeningeal Metastasis Group proposal to assess response to treatment: lack of feasibility and clinical utility and a revised proposal.Neuro Oncol.2019;21(5):648–658.
le Rhun
E
,
Devos
P
,
Boulanger
T
,
The RANO Leptomeningeal Metastasis Group proposal to assess response to treatment: lack of feasibility and clinical utility and a revised proposal
.Neuro Oncol
.
2019
;
21
(
5
):
648
–
658
.)| false
WangTJ,SaadS,QureshiYH,et al.Outcomes of gamma knife radiosurgery, bi-modality & tri-modality treatment regimens for patients with one or multiple brain metastases: the Columbia University Medical Center experience.J Neurooncol.2015;122(2):399–408.
Wang
TJ
,
Saad
S
,
Qureshi
YH
,
Outcomes of gamma knife radiosurgery, bi-modality & tri-modality treatment regimens for patients with one or multiple brain metastases: the Columbia University Medical Center experience
.J Neurooncol
.
2015
;
122
(
2
):
399
–
408
.)| false
AoyamaH,TagoM,ShiratoH.Stereotactic radiosurgery with or without whole-brain radiotherapy for brain metastases: secondary analysis of the JROSG 99-1 randomized clinical trial.JAMA Oncol.2015;1(4):457–464.
Aoyama
H
,
Tago
M
,
Shirato
H
.
Stereotactic radiosurgery with or without whole-brain radiotherapy for brain metastases: secondary analysis of the JROSG 99-1 randomized clinical trial
.JAMA Oncol
.
2015
;
1
(
4
):
457
–
464
.)| false
BrownPD,JaeckleK,BallmanKV,et al.Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial.JAMA.2016;316(4):401–409.
Brown
PD
,
Jaeckle
K
,
Ballman
KV
,
Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial
.JAMA
.
2016
;
316
(
4
):
401
–
409
.)| false
lagerwaardFJ,levendagPC,NowakPJ,EijkenboomWM,汉森PE,SchmitzPI.Identification of prognostic factors in patients with brain metastases: a review of 1292 patients.Int J Radiat Oncol Biol Phys.1999;43(4):795–803.
SubbiahIM,leiX,WeinbergJS,et al.Validation and development of a modified breast graded prognostic assessment as a tool for survival in patients with breast cancer and brain metastases.J Clin Oncol.2015;33(20):2239–2245.
Subbiah
IM
,
lei
X
,
Weinberg
JS
,
Validation and development of a modified breast graded prognostic assessment as a tool for survival in patients with breast cancer and brain metastases
.J Clin Oncol
.
2015
;
33
(
20
):
2239
–
2245
.)| false
ChidelMA,SuhJH,ReddyCA,ChaoST,lundbeckMF,BarnettGH.Application of recursive partitioning analysis and evaluation of the use of whole brain radiation among patients treated with stereotactic radiosurgery for newly diagnosed brain metastases.Int J Radiat Oncol Biol Phys.2000;47(4):993–999.
KayamaT,SatoS,SakuradaK,et al.Effects of surgery with salvage stereotactic radiosurgery versus surgery with whole-brain radiation therapy in patients with one to four brain metastases (JCOG0504): a phase III, noninferiority, randomized controlled trial.J Clin Oncol.Published online June 20, 2018. doi:10.1200/JCO.2018.78.6186
Kayama
T
,
Sato
S
,
Sakurada
K
,
Effects of surgery with salvage stereotactic radiosurgery versus surgery with whole-brain radiation therapy in patients with one to four brain metastases (JCOG0504): a phase III, noninferiority, randomized controlled trial
.J Clin Oncol
.
Published online June 20, 2018
. doi:
10.1200/JCO.2018.78.6186)| false
Iorio-MorinC,Masson-Côtél,EzahrY,BlanchardJ,EbacherA,MathieuD.Early Gamma Knife stereotactic radiosurgery to the tumor bed of resected brain metastasis for improved local control.J Neurosurg.2014;121(suppl):69-74.
Iorio-Morin
C
,
Masson-Côté
l
,
Ezahr
Y
,
Blanchard
J
,
Ebacher
A
,
Mathieu
D
.
Early Gamma Knife stereotactic radiosurgery to the tumor bed of resected brain metastasis for improved local control
.J Neurosurg
.
2014
;
121
(
suppl
):
69
-
74
.)| false
Gans
JH
,
Raper
DM
,
Shah
AH
,
The role of radiosurgery to the tumor bed after resection of brain metastases
.开云体育app官方网站下载入口
.
2013
;
72
(
3
):
317
–
326
.)| false
SolimanH,DasS,larsonDA,SahgalA.Stereotactic radiosurgery (SRS) in the modern management of patients with brain metastases.Oncotarget.2016;7(11):12318–12330.
Soliman
H
,
Das
S
,
larson
DA
,
Sahgal
A
.
Stereotactic radiosurgery (SRS) in the modern management of patients with brain metastases
.Oncotarget
.
2016
;
7
(
11
):
12318
–
12330
.)| false
SperdutoPW,ShanleyR,luoX,et al.Secondary analysis of RTOG 9508, a phase 3 randomized trial of whole-brain radiation therapy versus WBRT plus stereotactic radiosurgery in patients with 1-3 brain metastases; poststratified by the graded prognostic assessment (GPA).Int J Radiat Oncol Biol Phys.2014;90(3):526–531.
Sperduto
PW
,
Shanley
R
,
luo
X
,
Secondary analysis of RTOG 9508, a phase 3 randomized trial of whole-brain radiation therapy versus WBRT plus stereotactic radiosurgery in patients with 1-3 brain metastases; poststratified by the graded prognostic assessment (GPA)
.Int J Radiat Oncol Biol Phys
.
2014
;
90
(
3
):
526
–
531
.)| false
BhatnagarAK,FlickingerJC,KondziolkaD,lunsfordlD.Stereotactic radiosurgery for four or more intracranial metastases.Int J Radiat Oncol Biol Phys.2006;64(3):898–903.
HughesRT,MastersAH,McTyreER,et al.Initial SRS for patients with 5 to 15 brain metastases: results of a multi-institutional experience.Int J Radiat Oncol Biol Phys.2019;104(5):1091–1098.
Vellayappan
B
,
Tan
CL
,
Yong
C
,
Diagnosis and management of radiation necrosis in patients with brain metastases
.Front Oncol
.
2018
;
8
:
395
.)| false
KohutekZA,YamadaY,ChanTA,et al.long-term risk of radionecrosis and imaging changes after stereotactic radiosurgery for brain metastases.J Neurooncol.2015;125(1):149–156.
HuangAJ,HuangKE,PageBR,et al.Risk factors for leptomeningeal carcinomatosis in patients with brain metastases who have previously undergone stereotactic radiosurgery.J Neurooncol.2014;120(1):163–169.
OjerholmE,李JY,ThawaniJP,et al.Stereotactic radiosurgery to the resection bed for intracranial metastases and risk of leptomeningeal carcinomatosis.J Neurosurg.2014;121(suppl):75-83.
SubramaniamS,AalbergJJ,SorianoRP,DivinoCM.New 5-factor modified frailty index using American College of Surgeons NSQIP data.J Am Coll Surg.2018;226(2):173–181.e8.
Subramaniam
S
,
Aalberg
JJ
,
Soriano
RP
,
Divino
CM
.
New 5-factor modified frailty index using American College of Surgeons NSQIP data
.J Am Coll Surg
.
2018
;
226
(
2
):
173
–
181.e8
.)| false
