Stereotactic radiosurgery of benign brain tumors in elderly patients: evaluation of outcome and toxicity
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RESEARCH
Stereotactic radiosurgery of benign brain tumors in elderly patients: evaluation of outcome and toxicity Daniel Rueß1* , Vera Weyer1, Juman Tutunji1, Stefan Grau2, Martin Kocher1, Mauritius Hoevels1, Harald Treuer1, Christian Baues3 and Maximilian I. Ruge1
Abstract Background: Stereotactic 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. Methods: All 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), Results: We 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 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. Conclusion: SRS 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. Keywords: Radiosurgery, Vestibular schwannoma, Meningioma, Elderly patients 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], a *Correspondence: daniel.ruess@uk‑koeln.de 1 Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany Full list of author information is available at the end of the article
marked increase compared to 2000 where the life expectancy was 64 years for males and 68 years for females [2]. Since the incidence of benign brain tumors such as meningiomas and schwannomas increases with age [3], the medical care systems are facing an increasing number of older patients who suffer from these tumors. Concerning higher co-morbidity rates, treatment concepts in older patients should aim at balancing tumor control against procedural risk. In addition to micro-neurosurgery, stereotactic radiosurgery (SRS) has evolved as a generally accepted
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons
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