Quality-of-life trajectories after stereotactic radiosurgery for brain metastases

Adomas Bunevicius MD, PhD1, Karen Lavezzo RN, BSN1, Leah Shabo BS2, Jesse McClure PharmD, PhD2, and Jason P. Sheehan MD, PhD1
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  • 1 Department of Neurological Surgery, University of Virginia Health System; and
  • | 2 School of Medicine, University of Virginia, Charlottesville, Virginia
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OBJECTIVE

Quality of life (QOL) is an important endpoint measure of cancer treatment. The authors’ goal was to evaluate QOL trajectories and prognostic value in cancer patients treated with stereotactic radiosurgery (SRS) for brain metastases.

METHODS

Patients who underwent Gamma Knife radiosurgery (GKRS) between January 2016 and November 2019 were prospectively evaluated for QOL using the EQ-5D-3L questionnaire before SRS and at follow-up visits. Only patients who had pre-SRS and at least 1 post-SRS QOL assessment were considered.

RESULTS

Fifty-four cancer patients underwent 109 GKRS procedures. The first post-SRS visit was at a median of 2.59 months (range 0.13–21.08 months), and the last post-SRS visit was at 14.72 months (range 2.52–45.21 months) after SRS. There was no statistically significant change in the EQ-5D index score (p = 0.539) at the first compared with last post-SRS visit. The proportion of patients reporting some problems on the EQ-5D dimension of self-care increased during the course of follow-up from 9% (pre-SRS visit) to 18% (last post-SRS visit; p = 0.03). The proportion of patients reporting problems on the EQ-5D dimensions of mobility, usual activities, pain/discomfort, and anxiety/depression remained stable during the course of follow-up (p ≥ 0.106). After adjusting for clinical variables, a higher recursive partitioning analysis (RPA) class (i.e., worse prognostic category) was independently associated with greater odds for EQ-5D index score deterioration (p = 0.050). Upfront whole-brain radiation therapy predicted deterioration of the EQ-5D self-care (p = 0.03) and usual activities (p = 0.024) dimensions, while a greater number of lesions predicted deterioration of the EQ-5D anxiety/depression dimension (p = 0.008). A lower pre-SRS EQ-5D index was associated with shorter survival independently from clinical and demographic variables (OR 18.956, 95% CI 2.793–128.64; p = 0.003).

CONCLUSIONS

QOL is largely preserved in brain metastasis patients treated with SRS. Higher RPA class, upfront whole-brain radiation therapy, and greater intracranial disease burden are independent predictors of post-SRS QOL deterioration. Worse pre-SRS QOL predicts shorter survival. Assessment of QOL is recommended in brain metastasis patients managed with SRS.

ABBREVIATIONS

EORTC = European Organization for Research and Treatment of Cancer; FACT-BR = Functional Assessment of Cancer Therapy–Brain; GKRS = Gamma Knife radiosurgery; GPA = Graded Prognostic Assessment; QOL = quality of life; RPA = recursive partitioning analysis; SRS = stereotactic radiosurgery; WBRT = whole-brain radiation therapy.

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Contributor Notes

Correspondence Jason P. Sheehan: University of Virginia Health System, Charlottesville, VA. jps2f@hscmail.mcc.virginia.edu.

INCLUDE WHEN CITING Published online July 10, 2020; DOI: 10.3171/2020.4.JNS20788.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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