Surgical Treatment of the Septuagenarian Patients Suffering From Brain Metastases: A Large Retrospective Observational Analytic Cohort-Comparison Study

BACKGROUND: The benefits associated to the surgical treatment of brain metastases (BMs) in elderly patients has been extensively debated due to their higher biological fragility, but we still miss a "threshold." The aim of this study is to evaluate their outcomes by a systematic comparison with a cohort of the youngest patients of our series of BMs. METHODS: The surgical, radiologic, and oncologic outcomes of patients suffering from BM have been retrospectively reviewed for the present study. The patients have been subsequently assigned, according to their age in 2 groups: group A (<45 years old) and group B (>70 years old). Patient, surgery, and lesion- related data were recorded to identify the relationships with the following outcome variables: postoperative Karnofsky performance status, complications, and accessibility to adjuvant treatment. RESULTS: The final cohort consisted of 309 patients, 201 men (65.2%) and 108 women (34.8%); average age was 39.1 +/- 3.4 years for group A and 74.8 +/- 2.9 years for group B. Expected survival was 6.15 +/- 2.18 months for group A and 5.01 +/- 2.43 months for group B. The statistical analysis disclosed no significant difference between the 2 groups, in term of postoperative Karnofsky performance status and the incidence of complications. Important, the accessibility to adjuvant treatment was not different between the 2 groups. CONCLUSIONS: The surgical treatment of BM in the septuagenarian patients is safe and effective. It increases the chances of long-term survival by preserving the functional and neurological status and leaving intact the accessibility to adjuvant treatments, similarly to what happens in the younger patients.