Health-related quality of life after Gamma Knife radiosurgery in patients with 1\u201310 brain metastases

Eline Verhaak,Patrick E J Hanssens,Karin Gehring,Wietske C M Schimmel,Wilco H M Emons,Margriet M Sitskoorn

doi:10.1007/s00432-020-03400-w

Abstract

PurposeIncreasingly more patients with multiple (> 4) brain metastases (BM) are being treated with stereotactic radiosurgery (SRS). Preserving patients’ health-related quality of life (HRQoL) is an important treatment goal. The aim of this study was to assess (individual) changes in HRQoL in patients with 1–10 BM over time.MethodsA total of 92 patients were assessed before (n = 92) and at 3 (n = 66), 6 (n = 53), and 9 (n = 41) months after Gamma Knife radiosurgery (GKRS), using the Functional Assessment of Cancer Therapy-Brain (FACT-Br). The course of HRQoL was analyzed using linear mixed models. Clinical minimally important differences were used to evaluate individual changes.ResultsAt group level, patients’ physical well-being worsened, whereas emotional well-being improved over 9 months. Scores on other HRQoL subscales did not change significantly. Number (1–3 versus 4–10) and volume (small, medium, and large) of BM did not influence HRQoL over time, except for the subscale additional concerns; medium intracranial tumor volume was associated with less additional concerns. On the individual level as well, physical well-being declined while emotional well-being improved in most patients over 9 months after GKRS. At patient level, however, most patients had both declines as well as improvements in the different HRQoL aspects.ConclusionOur results indicate that even in patients with up to 10 BM, both at group and individual subscale level, aspects of HRQoL remained stable over nine months after GKRS, except for an improvement in emotional well-being and a decline in physical well-being. Nevertheless, HRQoL scores varied considerably at the individual patient level.Trail registration numberClinicalTrials.gov Identifier: NCT02953756, November 3, 2016.

Highlights

10–35% of patients with advanced cancer develop brain metastases (BM) during the course of their disease (Achrol et al 2019; Arvold et al 2016)
Forty percent of patients had more than three BM and the most
BM brain metastases, FACT-Brain Functional Assessment of Cancer Therapy-Brain, FACT-General Functional Assessment of Cancer TherapyGeneral, GPA graded prognostic assessment, HRQoL health-related quality of life, KPS Karnofsky Performance Status, No number, NSCLC non-small cell lung cancer, RPA recursive partitioning analysis, SD standard deviation a Educational level according to Verhage (Verhage 1964) (7 levels): low = 1–4, middle = 5, high = 6–7 b Total volume of brain metastases by patient

Summary

Introduction

10–35% of patients with advanced cancer develop brain metastases (BM) during the course of their disease (Achrol et al 2019; Arvold et al 2016). Preserving health-related quality of life (HRQoL) is a highly important treatment goal in this patient group (Tsao 2015; van der Meer et al 2018; Wong et al 2008). Previous studies demonstrated stable HRQoL in patients with BM after. Journal of Cancer Research and Clinical Oncology (2021) 147:1157–1167 stereotactic radiosurgery (SRS) (Bragstad et al 2017; Habets et al 2016; Kirkpatrick et al 2015; Skeie et al 2017). For the physical aspects of HRQoL, contradictory results have been found (Verhaak et al 2020). Three studies reported a decline in the physical aspect of HRQoL (Habets et al 2016; Kotecha et al 2017; Miller et al 2017), whereas three other studies reported stable scores over time (Bragstad et al 2017; Kirkpatrick et al 2015; Skeie et al 2017)

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