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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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.


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.


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).


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.

Article Information

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

INCLUDE WHEN CITING Published online December 21, 2018; DOI: 10.3171/2018.8.JNS181599.

Disclosures The registry effort was supported by grant funding to NPA from BrainLab, Elekta, AANS, and ASTRO. Individual sites received nominal grant funding from NPA. Drs. Sheehan and Kondziolka serve as representatives for NPA.

Dr. Grills reports having stock ownership in and serving on the Executive Board of Directors of Greater Michigan Gamma Knife and receiving funding for non–study-related research from Elekta through her institution.

© AANS, except where prohibited by US copyright law.



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    Upper: Scatterplot of change in EQ5D-L score from time of initial assessment to the last follow-up time point for individual patients as recorded in the registry’s database. Data are plotted as a function of the time elapsed from each individual patient’s time of initial SRS. Lower: Differences in overall EQ5D-L score from the time of initial SRS to last follow-up for the overall cohort of 116 patients.

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    Differences in EQ5D-L anxiety and depression subscores from the time of initial SRS to last follow-up for the overall cohort of 116 patients. Circles represent patients tested.

  • View in gallery

    Differences in EQ5D-L pain and discomfort subscores from the time of initial SRS to last follow-up for the overall cohort of 116 patients. Circles represent patients tested.





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