{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:19:20Z","timestamp":1790997560426,"version":"4.1.0"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2020,10,17]],"date-time":"2020-10-17T00:00:00Z","timestamp":1602892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Prognostic estimates for patients with brain metastases (BM) stem from younger, healthier patients enrolled in clinical trials or databases from academic centers. We characterized population-level prognosis in elderly patients with BM.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using Surveillance, Epidemiology, and End Results (SEER)\u2013Medicare data, we identified 9882 patients \u226565 years old with BM secondary to lung, breast, skin, kidney, esophageal, colorectal, and ovarian primaries between 2014 and 2016. Survival was assessed by primary site and evaluated with Cox regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 2765 versus 7117 patients were diagnosed with BM at primary cancer diagnosis (synchronous BM, median survival\u2005=\u20052.9 mo) versus thereafter (metachronous BM, median survival\u2005=\u20053.4 mo), respectively. Median survival for all primary sites was \u22644 months, except ovarian cancer (7.5 mo). Patients with non-small-cell lung cancer (NSCLC) receiving epidermal growth factor receptor (EGFR)\u2013 or anaplastic lymphoma kinase (ALK)\u2013based therapy for synchronous BM displayed notably better median survival at 12.5 and 20.1 months, respectively, versus 2.8 months exhibited by other patients with NSCLC; survival estimates in melanoma patients based on receipt of BRAF\/MEK therapy versus not were 6.7 and 2.8 months, respectively. On multivariable regression, older age, greater comorbidity, and type of managing hospital were associated with poorer survival; female sex, higher median household income, and use of brain-directed stereotactic radiation, neurosurgical resection, or systemic therapy (versus brain-directed non-stereotactic radiation) were associated with improved survival (all P\u2005&amp;lt;\u20050.05).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Elderly patients with BM have a poorer prognosis than suggested by prior algorithms. If prognosis is driven by systemic and not intracranial disease, brain-directed therapy with potential for significant toxicity should be utilized cautiously.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/neuonc\/noaa233","type":"journal-article","created":{"date-parts":[[2020,10,13]],"date-time":"2020-10-13T12:36:36Z","timestamp":1602592596000},"page":"661-676","source":"Crossref","is-referenced-by-count":47,"title":["Population-based estimates of survival among elderly patients with brain metastases"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2598-6529","authenticated-orcid":false,"given":"Nayan","family":"Lamba","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel Brigell","family":"Kearney","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J","family":"Catalano","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Harvard T.H. Chan School of Public Health, and Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Hassett","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick Y","family":"Wen","sequence":"additional","affiliation":[{"name":"Center for Neuro-Oncology, Dana-Farber\/Brigham and Women\u2019s Cancer Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2378-4800","authenticated-orcid":false,"given":"Daphne A","family":"Haas-Kogan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayal A","family":"Aizer","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,10,17]]},"reference":[{"issue":"1","key":"2021041218432964900_CIT0001","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s11912-011-0203-y","article-title":"Epidemiology of brain metastases","volume":"14","author":"Nayak","year":"2012","journal-title":"Curr Oncol Rep."},{"issue":"1","key":"2021041218432964900_CIT0002","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1038\/s41572-018-0055-y","article-title":"Brain metastases","volume":"5","author":"Achrol","year":"2019","journal-title":"Nat Rev Dis 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