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 (BM) in elderly patients has been extensively debated due to their higher biological fragility, but we still miss a "threshold". The aim of this work is to critically evaluate their outcomes by a systematic comparison to the cohort of the youngest patients of our series of BM. Methods: The surgical, radiological 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 two different subgroups: 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: 1.Postoperative KPS, 2.Complications and 3.Accessibility to adjuvant treatment. Results: The final cohort consisted of 309 patients, 201 males(65.2%) and 108 females(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 two different subgroups, in term of postoperative KPS and the incidence of complications. Importantly, the accessibility to adjuvant treatment was not different among the two subgroups either. 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