Abstract
After stereotactic radiosurgery (srs) for brain metastases, patients are routinely monitored with magnetic resonance imaging (mri). The high rate of new brain metastases after srs treatment alone might not be as concerning with modern mri and target localization treatment. Intensive surveillance might induce anxiety, lowering the patient's quality of life (qol). The present work is the feasibility component of a prospective study evaluating the role of surveillance mri on qol in patients with limited (1-3) brain metastases. Patients with limited brain metastases treated with srs alone, an Eastern Cooperative Oncology Group performance status of 2 or less, and documented stability in treated lesions, with no new lesions seen on mri at weeks 6-10 after srs, were eligible. All were asked about their interest in participating in the control (mri and clinical surveillance) or the experimental arm (symptom-directed mri and clinical surveillance). If 33% or more agreed to participate in the experimental arm, it would be considered feasible to conduct the prospective study. From November 2014 to July 2015, 45% of patients (10 of 22) agreed to participate in the experimental arm. Subgroup analyses found that the decision to participate has no statistically significant association with time of presentation (p = 0.696), display of symptoms (p = 0.840), age (p = 0.135), or number of lesions (p = 0.171). Results show that it is feasible to conduct the prospective cohort study. Because of the small sample size, we are limited in the conclusions able to be drawn in the subgroup analyses. However, the future study would allow for a better understanding of the attitudes of patients toward mri and its effect on qol.
Highlights
After stereotactic radiosurgery for brain metastases, patients are routinely monitored with magnetic resonance imaging
Patients with limited brain metastases treated with srs alone, an Eastern Cooperative Oncology Group performance status of 2 or less, and documented stability in treated lesions, with no new lesions seen on mri at weeks 6–10 after srs, were eligible
Eligible participants included all patients seen in a neuro-oncology follow-up clinic who had undergone srs for 1–3 brain metastases within the preceding 6–10 weeks, who had stable disease, who had no lesion larger than 3.0 cm, who had received no treatment for brain metastases before the initial srs treatment, and who had a Karnofsky performance status greater than 60
Summary
After stereotactic radiosurgery (srs) for brain metastases, patients are routinely monitored with magnetic resonance imaging (mri). The present work is the feasibility component of a prospective study evaluating the role of surveillance mri on qol in patients with limited (1–3) brain metastases. Patients can receive the appropriate treatment in a timely manner, preventing disease from progressing further and lowering the risk of death. Taking advantage of such modern technologies, radiologic surveillance is currently incorporated into the follow-up routine for cancer patients who have undergone radiosurgery for brain metastases[1]. Whether there is a quality of life (qol) or survival advantage to detecting asymptomatic recurrent brain metastases after srs remains unknown[3]. Participation in the control arm consisted of clinical and mri follow-up every
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