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.
ABBREVIATIONSASTRO = 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.
Correspondence Jason P. Sheehan: University of Virginia Health System, Charlottesville, VA. email@example.com.
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.
BragstadSFlatebøMNatvigGKEideGESkeieGOBehbahaniM: Predictors of quality of life and survival following Gamma Knife surgery for lung cancer brain metastases: a prospective study. J Neurosurg129:71–832018
BragstadS, FlatebøM, NatvigGK, EideGE, SkeieGO, BehbahaniM, : Predictors of quality of life and survival following Gamma Knife surgery for lung cancer brain metastases: a prospective study. 129:71–83, 20182882030410.3171/2017.2.JNS161659)| false
ChangELWefelJSHessKRAllenPKLangFFKornguthDG: Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol10:1037–10442009
ChangEL, WefelJS, HessKR, AllenPK, LangFF, KornguthDG, : Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. 10:1037–1044, 200910.1016/S1470-2045(09)70263-319801201)| false
EmeryATrifilettiDMRomanoKDPatelNSmolkinMESheehanJP: More than just the number of brain metastases: evaluating the impact of brain metastasis location and relative volume on overall survival after stereotactic radiosurgery. World Neurosurg99:111–1172017
EmeryA, TrifilettiDM, RomanoKD, PatelN, SmolkinME, SheehanJP: More than just the number of brain metastases: evaluating the impact of brain metastasis location and relative volume on overall survival after stereotactic radiosurgery. 99:111–117, 20172791976110.1016/j.wneu.2016.11.119)| false
MillerJA, KotechaR, BarnettGH, SuhJH, AngelovL, MurphyES, : Quality of life following stereotactic radiosurgery for single and multiple brain metastases. 81:147–155, 201710.1093/neuros/nyw16628327994)| false
PashosCL, FlowersCR, KayNE, WeissM, LamannaN, FarberC, : Association of health-related quality of life with gender in patients with B-cell chronic lymphocytic leukemia. 21:2853–2860, 201310.1007/s00520-013-1854-z23748484)| false
PickardASJiangRLinHWRosenbloomSCellaD: Using patient-reported outcomes to compare relative burden of cancer: EQ-5D and Functional Assessment of Cancer Therapy-General in eleven types of cancer. Clin Ther38:769–7772016
PickardAS, JiangR, LinHW, RosenbloomS, CellaD: Using patient-reported outcomes to compare relative burden of cancer: EQ-5D and Functional Assessment of Cancer Therapy-General in eleven types of cancer. 38:769–777, 201610.1016/j.clinthera.2016.03.00927041407)| false
SkeieBS, EideGE, FlatebøM, HeggdalJI, LarsenE, BragstadS, : Quality of life is maintained using Gamma Knife radiosurgery: a prospective study of a brain metastases patient cohort. 126:708–725, 201710.3171/2015.10.JNS1580127058206)| false
SoffiettiRKocherMAbaciogluUMVillaSFauchonFBaumertBG: A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. J Clin Oncol31:65–722013
SoffiettiR, KocherM, AbaciogluUM, VillaS, FauchonF, BaumertBG, : A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. 31:65–72, 201323213105)| false
TrifilettiDMLeeCCKanoHCohenJJanopaul-NaylorJAlonso-BasantaM: Stereotactic radiosurgery for brainstem metastases: an international cooperative study to define response and toxicity. Int J Radiat Oncol Biol Phys96:280–2882016
TrifilettiDM, LeeCC, KanoH, CohenJ, Janopaul-NaylorJ, Alonso-BasantaM, : Stereotactic radiosurgery for brainstem metastases: an international cooperative study to define response and toxicity. 96:280–288, 20162747816610.1016/j.ijrobp.2016.06.009)| false
TrifilettiDM, SheehanJP, GroverS, DuttaSW, RusthovenCG, KavanaghBD, : National trends in radiotherapy for brain metastases at time of diagnosis of non-small cell lung cancer. 45:48–53, 20172886607310.1016/j.jocn.2017.08.028)| false
ZindlerJDBruynzeelAMEEekersDBPHurkmansCWSwinnenALambinP: Whole brain radiotherapy versus stereotactic radiosurgery for 4–10 brain metastases: a phase III randomised multicentre trial. BMC Cancer17:5002017