Health-related quality of life in adult patients with brain metastases after stereotactic radiosurgery: a systematic, narrative review

Eline Verhaak,Neil K Aaronson,Karin Gehring,Margriet M Sitskoorn,Patrick E J Hanssens

doi:10.1007/s00520-019-05136-x

Abstract

PurposeA growing number of patients with brain metastases (BM) are being treated with stereotactic radiosurgery (SRS), and the importance of evaluating the impact of SRS on the health-related quality of life (HRQoL) in these patients has been increasingly acknowledged. This systematic review summarizes the current knowledge about the HRQoL of patients with BM after SRS.MethodsWe searched EMBASE, Medline Ovid, Web-of-Science, the Cochrane Database, PsycINFO Ovid, and Google Scholar up to November 15, 2018. Studies in patients with BM in which HRQoL was assessed before and after SRS and analyzed over time were included. Studies including populations of several types of brain cancer and/or several types of treatments were included if the results for patients with BM and treatment with SRS alone were described separately.ResultsOut of 3638 published articles, 9 studies met the eligibility criteria and were included. In 4 out of 7 studies on group results, overall HRQoL of patients with BM remained stable after SRS. In small study samples of longer-term survivors, overall HRQoL remained stable up to 12 months post-SRS. Contradictory results were reported for physical and general/global HRQoL, which might be explained by the different questionnaires that were used.ConclusionsIn general, SRS does not have significant negative effects on patients’ overall HRQoL over time. Future research is needed to analyze different aspects of HRQoL, differences in individual changes in HRQoL after SRS, and factors that influence these changes. These studies should take into account several methodological issues as discussed in this review.

Highlights

Brain metastases (BM) originate from a malignancy outside the central nervous system
Most patients with BM have been treated with whole brain radiation therapy (WBRT) [3, 8, 9]
A systematic literature search was conducted to identify studies in which adult patients with BM were treated with stereotactic radiosurgery (SRS), and health-related quality of life (HRQoL) was assessed by means of a self-report questionnaire

Summary

Introduction

Brain metastases (BM) originate from a malignancy outside the central nervous system. Most patients with BM have been treated with whole brain radiation therapy (WBRT) [3, 8, 9]. Due to advances in the technology, and the increased availability, of stereotactic radiosurgery (SRS) and concerns about the long-term side effects of WBRT, radiation treatment is shifting toward SRS [3, 10–12]. The high precision of SRS spares healthy brain tissue, reducing the risks of long-term side effects [13, 14]. SRS is usually delivered in one fraction, it can be delivered in up to five fractions using a linear accelerator, particle beam accelerator or multisource Cobalt-60 unit [15]

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