Quality of life after whole brain radiotherapy compared with radiosurgery of the tumor bed: results from a randomized trial

Kępka, Lucyna; Tyc-Szczepaniak, Dobromira; Osowiecka, Karolina; Sprawka, Arkadiusz; Trabska-Kluch, B.; Czeremszynska, B.

doi:10.1007/s12094-017-1703-5

Cited by 23 publications

(17 citation statements)

References 21 publications

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“…Our study has several limitations. First, although the examination compliance in our study population was better (85% at 4 months) than that reported in other studies (59-73% at 2-4 months) [6,8,11,[21][22][23], there were patients who could not perform the follow up examinations. Second, this study was unable to perform multivariate analysis that considers confounding factors related to cognitive dysfunction such as opioids [24], chemotherapy [25], surgery, etc..…”

Section: Discussioncontrasting

confidence: 75%

The neurocognitive function change criteria after whole-brain radiation therapy for brain metastasis, in reference to health-related quality of life changes: a prospective observation study

et al. 2020

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Background: We sought to construct the optimal neurocognitive function (NCF) change criteria sensitive to healthrelated quality of life (HR-QOL) in patients who have undergone whole-brain radiation therapy (WBRT) for brain metastasis. Methods: We categorized the patients by the changes of NCF into groups of improvement versus deterioration if at least one domain showed changes that exceeded the cutoff while other domains remained stable. The remaining patients were categorized as stable, and the patients who showed both significant improvement and deterioration were categorized as 'both.' We examined the clinical meaning of NCF changes using the cutoff values 1.0, 1.5, and 2.0 SD based on the percentage of patients whose HR-QOL changes were ≥ 10 points. Results: Baseline, 4-month and 8-month data were available in 78, 41 (compliance; 85%), and 29 (81%) patients, respectively. At 4 months, improvement/stable/deterioration/both was seen in 15%/12%/41%/32% of the patients when 1.0 SD was used; 19%/22%/37%/22% with 1.5 SD, and 17%/37%/37%/9% with 2.0 SD. The HR-QOL scores on the QLQ-C30 functional scale were significantly worse in the deterioration group versus the others with 1.0 SD (p = 0.013) and 1.5 SD (p = 0.015). With 1.5 SD, the HR-QOL scores on the QLQ-BN20 was significantly better in the improvement group versus the others (p = 0.033). However, when 'both' was included in 'improvement' or 'deterioration,' no significant difference in HR-QOL was detected. Conclusions: The NCF cutoff of 1.5 SD and the exclusion of 'both' patients from the 'deterioration' and 'improvement' groups best reflects HR-QOL changes.

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Section: Discussioncontrasting

confidence: 75%

The neurocognitive function change criteria after whole-brain radiation therapy for brain metastasis, in reference to health-related quality of life changes: a prospective observation study

et al. 2020

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“…In contrast, Cheng et al reported early cognitive impairment at one month after WBI, likely due to the frontal lobe damage [12] . Between these opposing positions, Kepka et al [13] supported that the omission of WBI after post-operative SRS delivered to the tumor bed affected the quality of life (QoL) and survival rates due to a poor sub-clinical disease control. These data have also been observed by Aoyama et al [14] in a prospective study.…”

Section: Introduction/rationalementioning

confidence: 99%

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

Ferini¹,

Viola²,

Valenti³

et al. 2022

Clinical and Translational Radiation Oncology

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To evaluate neurocognitive performance, daily activity and quality of life (QoL), other than usual oncologic outcomes, among patients with brain metastasis ≥5 (MBM) from solid tumors treated with Stereotactic Brain Irradiation (SBI) or Whole Brain Irradiation (WBI). Methods: This multicentric randomized controlled trial will involve the enrollment of 100 patients (50 for each arm) with MBM ≥ 5, age ≥ 18 years, Karnofsky Performance Status (KPS) ≥ 70, life expectancy > 3 months, known primary tumor, with controlled or controllable extracranial disease, baseline Montreal Cognitive Assessment (MoCA) score ≥ 20/30, Barthel Activities of Daily Living score ≥ 90/100, to be submitted to SBI by LINAC with monoisocentric technique and non-coplanar arcs (experimental arm) or to WBI (control arm). The primary endpoints are neurocognitive performance, QoL and autonomy in daily-life activities variations, the first one assessed by MoCa Score and Hopkins Verbal Learning Test-Revised, the second one through the EORTC QLQ-C15-PAL and QLQ-BN-20 questionnaires, the third one through the Barthel Index, respectively. The secondary endpoints are time to intracranial failure, overall survival, retreatment rate, acute and late toxicities, changing of KPS. It will be considered significant a statistical difference of at least 30% between the two arms (statistical power of 80% with a significance level of 95%). Discussion: Several studies debate what is the decisive factor accountable for the development of neurocognitive decay among patients undergoing brain irradiation for MBM: radiation effect on clinically healthy brain tissue or intracranial tumor burden? The answer to this question may come from the recent technological advancement

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“…Irrespective of these different statistical scenarios, systemic treatment significantly improved survival. At present, many patients receive other types of brain irradiation, such as stereotactic radiosurgery (SRS), which may provide a better therapeutic ratio [16][17][18]. However, sophisticated local treatment is less appealing if followed by best supportive care (BSC) rather than systemic therapy.…”

Section: Introductionmentioning

confidence: 99%

Recursive Partitioning Analysis of Systemic Therapy after Radiotherapy in Patients with Brain Metastases

2021

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Purpose: The purpose of this study was to identify factors associated with the initiation or continuation of systemic treatment after brain irradiation. The outcome of interest was a utilization rate of at least 75%, given that active extracranial disease is common in patients with brain metastases. If left untreated, extracranial disease limits survival, regardless of successful local treatment of the brain metastases. In this context, systemic therapy has been shown to improve survival, e.g., after whole-brain radiotherapy. Patients and Methods: The study included 185 patients with active extracranial disease, 60% of whom received systemic therapy. Results: Survival from the start of brain irradiation was longest in patients who received additional immune checkpoint inhibitors, endocrine treatment, or anti-HER-2 drugs. After uni- and multivariate analyses, Eastern Cooperative Oncology Group performance status (PS) was selected as the first prediction criterion in the recursive partitioning analysis (RPA) decision tree analysis. RPA was successful for patients with PS 0–1, but patients with PS 2 had lower treatment utilization rates (maximum 60–70%, with a disease-dependent impact of age and LabBM score [blood test results]). The highest utilization rates were observed in (1) patients with PS 0 and (2) those with breast cancer, small-cell lung cancer, or lung adenocarcinoma with PS 1. Conclusions: These results inform the multidisciplinary discussion and treatment planning for the common scenario of simultaneous intra- and extracranial metastases.

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Quality of life after whole brain radiotherapy compared with radiosurgery of the tumor bed: results from a randomized trial

Cited by 23 publications

References 21 publications

The neurocognitive function change criteria after whole-brain radiation therapy for brain metastasis, in reference to health-related quality of life changes: a prospective observation study

The neurocognitive function change criteria after whole-brain radiation therapy for brain metastasis, in reference to health-related quality of life changes: a prospective observation study

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

Recursive Partitioning Analysis of Systemic Therapy after Radiotherapy in Patients with Brain Metastases

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