P11.34.A MULTIFACTORIAL ANALYSIS OF SURGICAL TREATMENT OF INTRACRANIAL METASTASES IN ELDERLY PATIENTS

Abstract

Abstract BACKGROUND Due to increasing age of the population, the number of elderly patients with brain metastasis accessible for surgery is increasing. The higher risk of peri-procedural complications and a reduced ability to tolerate aggressive treatment are often thought to limit intracranial surgery in older patients. However, little data are available on results of surgical brain metastasis treatment in elderly. In a subset of older patients who underwent surgical removal of brain metastases, we assessed the influence of age on survival and postoperative dependency. MATERIAL AND METHODS This is a retrospective observational study of patients over 65 years of age who underwent surgery for intracranial metastases between 2015 and 2022 at the Department of Neurosurgery, University Hospital Mannheim (Germany). The population was divided into group A (65-74 years old) and group B (75 years or older). The Eastern Cooperative Oncology Group (ECOG) score was used to assess functional status and independence. The primary endpoints were overall survival and the likelihood of remaining independent (ECOG <3) at 6 weeks. A wide range of clinical and radiological baseline factors were analysed. RESULTS 80 patients were included in the analysis. The mean age in the overall cohort was 73.2 years, and 74% of patients had a preoperative ECOG score of 2 or less. 48 patients were included in group A and 32 in group B. The 1-, 2- and 3-year probabilities of overall survival were 31%, 23% and 16% in group A and 38%, 23% and 23% in group B (p-value=0.61). Functional status in the overall cohort remained stable after surgery for most patients (70%), while 17% experienced a decline and 13% an improvement. 42 (88%) and 43 (90%) patients in group A were independent before and after surgery, respectively. 27 (84%) and 26 (81%) patients in group B were independent before and after surgery, respectively. 33 (69%) patients in group A and 19 (59%) patients in group B were independent at follow-up (p=0.65). No significant difference was found between the two groups for independence status preoperatively, postoperatively as well as at follow-up (p-values 0.69, 0.29 and 0.32, respectively). CONCLUSION In our analysis, neither survival nor outcome after surgery for brain metastases showed a correlation with age. Age alone should not be a barrier to intracranial surgery in carefully selected elderly patients with intracranial metastases.