Practicability and compliance appeared better with the (shorter) version B. This version is now used in the ongoing main phase of the study with additional centers. First results indicate a moderate worsening of QoL during the first 3 months after start of palliative radiotherapy for brain metastases. QoL at initiation of radiotherapy may be prognostic for survival.

BackgroundRecently published results of quality of life (QoL) studies indicated different outcomes of palliative radiotherapy for brain metastases. This prospective multi-center QoL study of patients with brain metastases was designed to investigate which QoL domains improve or worsen after palliative radiotherapy and which might provide prognostic information.MethodsFrom 01/2007-01/2009, n=151 patients with previously untreated brain metastases were recruited at 14 centers in Germany and Austria. Most patients (82 %) received whole-brain radiotherapy. QoL was measured with the EORTC-QLQ-C15-PAL and brain module BN20 before the start of radiotherapy and after 3 months.ResultsAt 3 months, 88/142 (62 %) survived. Nine patients were not able to be followed up. 62 patients (70.5 % of 3-month survivors) completed the second set of questionnaires. Three months after the start of radiotherapy QoL deteriorated significantly in the areas of global QoL, physical function, fatigue, nausea, pain, appetite loss, hair loss, drowsiness, motor dysfunction, communication deficit and weakness of legs. Although the use of corticosteroid at 3 months could be reduced compared to pre-treatment (63 % vs. 37 %), the score for headaches remained stable. Initial QoL at the start of treatment was better in those alive than in those deceased at 3 months, significantly for physical function, motor dysfunction and the symptom scales fatigue, pain, appetite loss and weakness of legs. In a multivariate model, lower Karnofsky performance score, higher age and higher pain ratings before radiotherapy were prognostic of 3-month survival.ConclusionsModerate deterioration in several QoL domains was predominantly observed three months after start of palliative radiotherapy for brain metastases. Future studies will need to address the individual subjective benefit or burden from such treatment. Baseline QoL scores before palliative radiotherapy for brain metastases may contain prognostic information.

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CT may help to identify extraluminal inflammatory changes and complications in diverticulitis. The degree of the inflammation can be classified and the surgical approach suitably influenced, respectively modified.

The knowledge of serum levels of azathioprine or its metabolite 6-mercaptopurine is important for the monitoring of the immunosuppressive therapy after kidney transplantation, especially when kidney function is low. For this reason, the work of Bailey et al. was modified. 6-Mercaptopurine was extracted from the serum with a mixture of isopropanol-ethylacetate (1:1 v:v), derivatized with trimethylaniliniumhydroxyde and measured gaschromatographically. Sulfhydryl-protecting reagents were added to prevent loss of substance. Oxyethyltheophylline was used as the internal standard. The extraction and clean-up method recovered 80% of the 6-mercaptopurine present, the lower limit of sensitivity was 20 ng/ml, i.e., ten times lower than that of Bailey et al. The method could be realized on eight patients treated with azathioprine, the half life of the drug was about 20-40 min within the first hour i.v. application.