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

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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.

  • 1

    Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep. 2012;14(1):4854.

  • 2

    Butowski NA. Epidemiology and diagnosis of brain tumors. Continuum (Minneap Minn). 2015;21(2 Neuro-oncology):301313.

  • 3

    Davis FG, Dolecek TA, McCarthy BJ, Villano JL. Toward determining the lifetime occurrence of metastatic brain tumors estimated from 2007 United States cancer incidence data. Neuro Oncol. 2012;14(9):11711177.

    • Search Google Scholar
    • Export Citation
  • 4

    Wen PY, Loeffler JS. Management of brain metastases. Oncol (Williston Park). 1999;13(7):941954, 957–962, 9.

  • 5

    Lin X, DeAngelis LM. Treatment of brain metastases. J Clin Oncol. 2015;33(30):34753484.

  • 6

    Soffietti R, Cornu P, Delattre JY, EFNS Guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force. Eur J Neurol. 2006;13(7):674681.

    • Search Google Scholar
    • Export Citation
  • 7

    Churilla TM, Ballman KV, Brown PD, Stereotactic radiosurgery with or without whole-brain radiation therapy for limited brain metastases: A secondary analysis of the North Central Cancer Treatment Group N0574 (Alliance) Randomized Controlled Trial. Int J Radiat Oncol Biol Phys. 2017;99(5):11731178.

    • Search Google Scholar
    • Export Citation
  • 8

    Kayama T, Sato S, Sakurada K, Effects of surgery with salvage stereotactic radiosurgery versus surgery with whole-brain radiation therapy in patients with one to four brain metastases (JCOG0504): A phase III, noninferiority, randomized controlled trial. J Clin Oncol. 2018;20:JCO2018786186.

    • Search Google Scholar
    • Export Citation
  • 9

    Chang EL, Wefel JS, Hess KR, Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10(11):10371044.

    • Search Google Scholar
    • Export Citation
  • 10

    Soffietti R, Kocher M, Abacioglu UM, 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 Oncol. 2013;31(1):6572.

    • Search Google Scholar
    • Export Citation
  • 11

    Yamamoto M, Serizawa T, Higuchi Y, A multi-institutional prospective observational study of stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901 Study Update): Irradiation-related complications and long-term maintenance of Mini-Mental State Examination scores. Int J Radiat Oncol Biol Phys. 2017;99(1):3140.

    • Search Google Scholar
    • Export Citation
  • 12

    Mauer M, Stupp R, Taphoorn MJB, The prognostic value of health-related quality-of-life data in predicting survival in glioblastoma cancer patients: results from an international randomised phase III EORTC Brain Tumour and Radiation Oncology Groups, and NCIC Clinical Trials Group study. Br J Cancer. 2007;97(3):302307.

    • Search Google Scholar
    • Export Citation
  • 13

    Bottomley A, Pe M, Sloan J, Analysing data from patient-reported outcome and quality of life endpoints for cancer clinical trials: a start in setting international standards. Lancet Oncol. 2016;17(11):e510e514.

    • Search Google Scholar
    • Export Citation
  • 14

    Ediebah DE, Quinten C, Coens C, Quality of life as a prognostic indicator of survival: A pooled analysis of individual patient data from Canadian cancer trials group clinical trials. Cancer. 2018;124(16):34093416.

    • Search Google Scholar
    • Export Citation
  • 15

    Quinten C, Coens C, Mauer M, Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials. Lancet Oncol. 2009;10(9):865871.

    • Search Google Scholar
    • Export Citation
  • 16

    Bragstad S, Flatebø M, Natvig GK, Predictors of quality of life and survival following Gamma Knife surgery for lung cancer brain metastases: a prospective study. J Neurosurg. 2018;129(1):7183.

    • Search Google Scholar
    • Export Citation
  • 17

    Miller JA, Kotecha R, Barnett GH, Quality of life following stereotactic radiosurgery for single and multiple brain metastases. Neurosurgery. 2017;81(1):147155.

    • Search Google Scholar
    • Export Citation
  • 18

    Sheehan JP, Grills I, Chiang VL, Quality of life outcomes for brain metastasis patients treated with stereotactic radiosurgery: pre-procedural predictive factors from a prospective national registry. J Neurosurg. 2018;131(6):18481854.

    • Search Google Scholar
    • Export Citation
  • 19

    Skeie BS, Eide GE, Flatebø M, Quality of life is maintained using Gamma Knife radiosurgery: a prospective study of a brain metastases patient cohort. J Neurosurg. 2017;126(3):708725.

    • Search Google Scholar
    • Export Citation
  • 20

    Burns TC, Awad AJ, Li MD, Grant GA. Radiation-induced brain injury: low-hanging fruit for neuroregeneration. Neurosurg Focus. 2016;40(5):E3.

    • Search Google Scholar
    • Export Citation
  • 21

    Greene-Schloesser D, Robbins ME, Peiffer AM, Radiation-induced brain injury: a review. Front Oncol. 2012;2:73.

  • 22

    Verhaak E, Gehring K, Hanssens PEJ, Health-related quality of life in adult patients with brain metastases after stereotactic radiosurgery: a systematic, narrative review. Support Care Cancer. 2020;28(2):473484.

    • Search Google Scholar
    • Export Citation
  • 23

    Sheehan JP, Kavanagh BD, Asher A, Harbaugh RE. Inception of a national multidisciplinary registry for stereotactic radiosurgery. J Neurosurg. 2016;124(1):155162.

    • Search Google Scholar
    • Export Citation
  • 24

    Sperduto PW, Kased N, Roberge D, Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol. 2012;30(4):419425.

    • Search Google Scholar
    • Export Citation
  • 25

    Gaspar L, Scott C, Rotman M, Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997;37(4):745751.

    • Search Google Scholar
    • Export Citation
  • 26

    Snell JW, Sheehan J, Stroila M, Steiner L. Assessment of imaging studies used with radiosurgery: a volumetric algorithm and an estimation of its error. Technical note. J Neurosurg. 2006;104(1):157162.

    • Search Google Scholar
    • Export Citation
  • 27

    Pickard AS, Wilke CT, Lin H-W, Lloyd A. Health utilities using the EQ-5D in studies of cancer. Pharmacoeconomics. 2007;25(5):365384.

  • 28

    Schwenkglenks M, Matter-Walstra K. Is the EQ-5D suitable for use in oncology? An overview of the literature and recent developments. Expert Rev Pharmacoecon Outcomes Res. 2016;16(2):207219.

    • Search Google Scholar
    • Export Citation
  • 29

    Kvam AK, Fayers PM, Wisloff F. Responsiveness and minimal important score differences in quality-of-life questionnaires: a comparison of the EORTC QLQ-C30 cancer-specific questionnaire to the generic utility questionnaires EQ-5D and 15D in patients with multiple myeloma. Eur J Haematol. 2011;87(4):330337.

    • Search Google Scholar
    • Export Citation
  • 30

    Salvetti DJ, Nagaraja TG, McNeill IT, Gamma Knife surgery for the treatment of 5 to 15 metastases to the brain: clinical article. J Neurosurg. 2013;118(6):12501257.

    • Search Google Scholar
    • Export Citation
  • 31

    Habets EJJ, Dirven L, Wiggenraad RG, Neurocognitive functioning and health-related quality of life in patients treated with stereotactic radiotherapy for brain metastases: a prospective study. Neuro Oncol. 2016;18(3):435444.

    • Search Google Scholar
    • Export Citation
  • 32

    van der Meer PB, Habets EJJ, Wiggenraad RG, Individual changes in neurocognitive functioning and health-related quality of life in patients with brain oligometastases treated with stereotactic radiotherapy. J Neurooncol. 2018;139(2):359368.

    • Search Google Scholar
    • Export Citation
  • 33

    Kotecha R, Damico N, Miller JA, Three or more courses of stereotactic radiosurgery for patients with multiply recurrent brain metastases. Neurosurgery. 2017;80(6):871879.

    • Search Google Scholar
    • Export Citation
  • 34

    Randolph DM, McTyre E, Klepin H, Impact of radiosurgical management of geriatric patients with brain metastases: clinical and quality of life outcomes. J Radiosurg SBRT. 2017;5(1):3542.

    • Search Google Scholar
    • Export Citation
  • 35

    Caruso R, Nanni MG, Riba M, Depressive spectrum disorders in cancer: prevalence, risk factors and screening for depression: a critical review. Acta Oncol. 2017;56(2):146155.

    • Search Google Scholar
    • Export Citation
  • 36

    Pranckeviciene A, Bunevicius A. Depression screening in patients with brain tumors: a review. CNS Oncol. 2015;4(2):7178.

  • 37

    Bunevicius A. Reliability and validity of the SF-36 Health Survey Questionnaire in patients with brain tumors: a cross-sectional study. Health Qual Life Outcomes. 2017;15(1):92.

    • Search Google Scholar
    • Export Citation
  • 38

    Brown PD, Jaeckle K, Ballman KV, Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA. 2016;316(4):401409.

    • Search Google Scholar
    • Export Citation
  • 39

    Montazeri A. Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008. Health Qual Life Outcomes. 2009;7:102.

    • Search Google Scholar
    • Export Citation
  • 40

    Wong E, Rowbottom L, Tsao M, Prognostic value of pre- and post-treatment health-related quality of life in predicting survival of patients with brain metastases. CNS Oncol. 2017;6(2):119129.

    • Search Google Scholar
    • Export Citation

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