How we treat octogenarians with brain metastases

Area of Science:

• Geriatric Oncology
• Neuro-oncology
• Cancer Treatment

Background:

• Octogenarians (80+ years) with cancer, particularly brain metastases, represent a growing and vulnerable patient group.
• Frailty, comorbidities, and cancer dissemination significantly influence treatment eligibility and outcomes in the elderly.
• Current prognostic scores may not accurately reflect outcomes in octogenarian populations.

Purpose of the Study:

• To review the tolerability and efficacy of various oncological treatments in biologically younger, independent octogenarians with brain metastases.
• To highlight the importance of multidisciplinary assessment for this patient group.
• To evaluate treatment outcomes and limitations of prognostic scores in octogenarians.

Main Methods:

• Review of treatment examples including surgery, radiosurgery, systemic therapy, and best supportive care for octogenarians with brain metastases.
• Discussion of factors influencing treatment decisions and outcomes, such as age, frailty, and performance status.
• Analysis of existing literature and prognostic scores, considering selection bias in retrospective studies.

Main Results:

• Biologically younger, independent octogenarians generally tolerate oncological treatments well.
• Frailty significantly limits eligibility for treatments like chemotherapy and surgery.
• Radiosurgery showed more encouraging survival rates compared to whole-brain radiotherapy in retrospective analyses, despite selection bias.

Conclusions:

• Multidisciplinary assessment is essential for managing octogenarians with brain metastases, considering their unique vulnerabilities.
• Treatment decisions must balance oncological goals with functional status and potential toxicities.
• Further prospective research focused on octogenarians is needed to refine treatment strategies and improve survival outcomes.