Journal of Neuro-Oncology

, Volume 137, Issue 3, pp 559–565 | Cite as

Identifying candidates for gamma knife radiosurgery among elderly patients with brain metastases

  • Tae Hoon Roh
  • Mi Sun Choi
  • Namkyu You
  • Donghwan Jeong
  • Ae Hwa Jang
  • Mi Ra Seo
  • Sang Ryul Lee
  • Se-Hyuk Kim
Clinical Study


We investigated the outcomes of gamma knife radiosurgery (GKRS) for elderly patients (≥ 65 years) with brain metastases, and identified survival-associated factors. We retrospectively analyzed data from 115 patients treated with GKRS for 1–15 brain metastases. The median patient age was 72 years; most primary tumors were pulmonary (n = 83). The mean lesion volume was 2.1 ± 4.8 mL. A mean dose of 19.3 Gy was delivered to the mean 63.9% isodose line. The median overall survival (OS) was 5.3 months (95% confidence interval [CI] 3.5–7.1). During follow-up (median, 5.1 months), 91 patients died of primary cancer progression while 1 died of unknown causes. The 6- and 12-month local control rates were 94.9 and 88.1%, respectively. On multivariate analysis, female sex (p = 0.005, hazard ratio [HR] 0.533, 95% CI 0.343–0.827) and a controlled primary tumor (p < 0.001, HR 0.328, 95% CI 0.180–0.596) were significantly favorable prognostic factors. Of non-small cell lung cancer patients with EGFR mutations, 76.5% were women (p = 0.005). The median OS of EGFR-mutant and EGFR-wildtype patients were 19.1 and 4.7 months, respectively (p = 0.080). Brain metastases < 3 mL showed better local control rates after GKRS (p = 0.005). GKRS produces favorable outcomes in women with brain metastases who are ≥ 65 years and have controlled primary tumors. Such patients are therefore suitable candidates for GKRS.


Age Metastasis Radiosurgery Survival 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Supplementary material

11060_2018_2745_MOESM1_ESM.pdf (85 kb)
Supplementary Fig. S1 Kaplan-Meier curves showing overall survival (OS) according to EGFR mutation status. The median OS rates for EGFR-mutant lung cancer vs. EGFR-wildtype lung cancer patients were 19.1 vs. 4.7 months, respectively (p=0.080) (PDF 84 KB)
11060_2018_2745_MOESM2_ESM.pdf (94 kb)
Supplementary Fig. S2 Kaplan-Meier curves showing local tumor control rates according to the tumor volume. The local progression-free survival at 12 months after gamma knife radiosurgery was 88.8% in patients with tumor volumes ≤3 mL and 71.3% in those with tumor volumes &#x003E;3 mL (PDF 93 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Tae Hoon Roh
    • 1
    • 2
  • Mi Sun Choi
    • 1
  • Namkyu You
    • 1
  • Donghwan Jeong
    • 1
  • Ae Hwa Jang
    • 1
  • Mi Ra Seo
    • 1
  • Sang Ryul Lee
    • 1
  • Se-Hyuk Kim
    • 1
  1. 1.Gamma Knife Center, Department of NeurosurgeryAjou University School of MedicineSuwonSouth Korea
  2. 2.Yonsei University Graduate SchoolSeoulSouth Korea

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