Stereotactic radiosurgery of benign brain tumors in elderly patients: evaluation of outcome and toxicity

Daniel Rueß,Stefan Grau,Maximilian I Ruge,Juman Tutunji,Mauritius Hoevels,Vera Weyer,Martin Kocher,Harald Treuer,Christian Baues

doi:10.1186/s13014-020-01714-0

Abstract

BackgroundStereotactic radiosurgery (SRS) is widely accepted as a therapeutic option for meningiomas (M) and vestibular schwannomas (VS). However, data on outcome and toxicity in the elderly population have rarely been reported in detail.MethodsAll patients aged ≥ 65 years with M or VS who underwent single fraction SRS were included. Patient data were analyzed in terms of clinical tumor control and incidence of early and late treatment related complications, which were graded according to the Common Terminology Criteria for Adverse Events (CTCAE),ResultsWe identified 245 patients with benign brain tumors (129 M and 116 VS, median tumor volume 2.9 ml, range 0.1–28). The median age was 71 years (range 65–86) and the mean follow-up times were 42 months (range 2–181). Tumors were irradiated with a median dose of 12.4 Gy. Actuarial clinical and radiological tumor control rates at 2, 5, and 10 years after SRS were 98%, 93%, and 88%, respectively. Recurrent tumors after previous treatment had a higher probability of post-radiosurgical progression (p < 0.001). Permanent toxicity (CTCAE I/II) were noted in 5.7%. No severe adverse events were observed during early and late follow up, although patients > 70 years had a slightly higher risk for toxicity (p = 0.027). The presence and extent of co-morbidities had no significant influence on local tumor control or toxicity.ConclusionSRS provides favorable tumor control with low risk for treatment-related severe complications. Thus, SRS should always be considered as treatment option for benign intracranial tumors (meningiomas, schwannomas), especially in the group of elderly patients.

Highlights

The life expectancy of the world’s population is continuously increasing
Patients and subjects In this single center retrospective analysis, we included patients suffering from either schwannoma or meningioma of grade WHO I who were, or above 65 years of age and were treated with SRS either by means of a modified linear accelerator (LINAC) or by robotic radiosurgery with the C yberknife® system (CK) within a defined period ranging from January 1991 to March 2018
Patient collective In our database, we identified 245 patients aged at least 65 years old suffering from meningioma (M) or vestibular schwannoma (VS) (Table 1)

Summary

Introduction

The life expectancy of the world’s population is continuously increasing. According to the latest WHO report from 2018, the global life expectancy of a child born in 2016 was 70 years for males and 74 years for females [1], aIn addition to micro-neurosurgery, stereotactic radiosurgery (SRS) has evolved as a generally acceptedRueß et al Radiat Oncol (2020) 15:274 effective therapeutic option, especially for meningiomas and schwannomas. The life expectancy of the world’s population is continuously increasing. Several studies have reported data on long-term follow-up with tumor control rates exceeding 90% and associated mild toxicity [4,5,6,7,8]. Only limited data are available regarding the efficacy and toxicity of SRS for benign brain tumors in the elderly patients group [9,10,11]. In this study, we investigated the efficacy and toxicity of SRS for the most frequent benign brain tumors in older patients. Stereotactic radiosurgery (SRS) is widely accepted as a therapeutic option for meningiomas (M) and vestibular schwannomas (VS). Data on outcome and toxicity in the elderly population have rarely been reported in detail

Methods

Results

Discussion

Conclusion