Prospective evaluation of quality of life effects in patients undergoing palliative radiotherapy for brain metastases

Abstract

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.

Hair-sparing whole brain radiotherapy with volumetric arc therapy in patients treated for brain metastases: dosimetric and clinical results of a phase II trial

“…Following a pre-planned interim analysis, the rules for futility were met, with a mean score of hair loss exceeding 56.7 on the EORTC BN20 (mean score of 95). The score of hair loss in our study was higher than in the literature, where in general scores between 30 and 40 are reported [4,6,26,27]. In the study of Steinman et al and Slotman et al, 42% and 22% of patients showed an increase in hair loss scores exceeding 20 points, respectively, compared to all patients in our study.…”

Quality of Life, Psychological Burden, and Sleep Quality in Patients With Brain Metastasis Undergoing Whole Brain Radiation Therapy

“…This study's finding of an average OS of 5.27 months (SD = 4.89) is similar to survival times in earlier studies (Andrews et al, 2004;Lin et al, 2013;Rades et al, 2008;Steinmann et al, 2012). Andrews et al (2004) determined that median survival was 6.7 months in patients with multiple metastases in a WBRT-alone group, whereas Steinmann et al (2012) noted that median OS was 4.5 months.…”

ZNS-Metastasen - eine interdisziplinäre Herausforderung

“…Eine große prospektive Studie mit 151 Patienten (90 Bronchialkarzinome, 25 Mammakarzinome, 12 Melanome), die sich wegen multipler Hirnmetastasen einer palliativen Ganzhirnbestrahlung unterziehen mussten, bestätigte die Verschlechterung der Lebensqualität 3 Monate nach der Radiotherapie, vor allem die Verschlechterung der allgemeinen und körperlichen Funktionen [8]. Die Lebensqualität wurde mit dem Kurzfragebogen QLQ-C15-PAL und dem Hirnmodul BN20 erhoben.…”