Quality of life outcomes for brain metastasis patients treated with stereotactic radiosurgery: pre-procedural predictive factors from a prospective national registry

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  • 1 Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia;
  • | 2 Penn State Medical Center, Hershey, Pennsylvania;
  • | 3 Department of Neurological Surgery, Yale University, New Haven, Connecticut;
  • | 4 Department of Neurological Surgery, New York University, New York, New York;
  • | 5 Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan;
  • | 6 Department of Radiation Oncology, University of Colorado, Denver, Colorado; and
  • | 7 Mayfield Clinic, Cincinnati, Ohio
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OBJECTIVE

Stereotactic radiosurgery (SRS) is increasingly used for the treatment of brain metastasis. To date, most studies have focused on survival, radiological response, or surrogate quality endpoints such as Karnofsky Performance Scale status or neurocognitive indices. The current study prospectively evaluated pre-procedural factors impacting quality of life in brain metastasis patients undergoing SRS.

METHODS

Using a national, cloud-based platform, patients undergoing SRS for brain metastasis were accrued to the registry. Quality of life prior to SRS was assessed using the 5-level EQ-5D (EQ5D-L) validated tool; additionally, patient and treatment attributes were collected. Patient quality of life was assessed as part of routine follow-up after SRS. Factors predicting a difference in the aggregate EQ5D-L score or the subscores were evaluated. Pre-SRS covariates impacting changes in EQ5D-L were statistically evaluated. Statistical analyses were conducted using multivariate linear regression models.

RESULTS

EQ5D-L results were available for 116 patients. EQ5D-L improvement (average of 0.387) was noted in patients treated with earlier SRS (p = 0.000175). Worsening overall EQ5D-L (average of 0.052 per lesion) was associated with an increased number of brain metastases at the time of initial presentation (p = 0.0399). Male sex predicted a risk of worsening (average of 0.347) of the pain and discomfort subscore at last follow-up (p = 0.004205). Baseline subscores of pain/discomfort were not correlated with pain/discomfort subscores at follow-up (p = 0.604), whereas baseline subscores of anxiety/depression were strongly positively correlated with the anxiety/depression follow-up subscores (p = 0.0039).

CONCLUSIONS

After SRS, quality of life was likely to improve in patients treated early with SRS and worsen in those with a greater number of brain metastases. Sex differences appear to exist regarding pain and discomfort worsening after SRS. Those with high levels of anxiety and depression at SRS may benefit from medical treatment as this particular quality of life factor generally remains unchanged after SRS.

ABBREVIATIONS

ASTRO = American Society for Radiation Oncology; BRCS = brain cancer subscale; EORTC = European Organisation for Research and Treatment of Cancer; EQ5D-L = 5-level EQ-5D; FACT-BR = Functional Assessment of Cancer Therapy–Brain; HRQOL = health-related QOL; KPS = Karnofsky Performance Scale; NPA = NeuroPoint Alliance; QOL = quality of life; SRS = stereotactic radiosurgery; WBRT = whole-brain radiotherapy.

Illustration from Miki et al (pp 1905–1911). Copyright Koichi Miki (right panel). Published with permission.

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