Individual changes in neurocognitive functioning and health-related quality of life in patients with brain oligometastases treated with stereotactic radiotherapy

Esther J J Habets,Martin J B Taphoorn,Hanneke Zwinkels,Antoinette Verbeek-De Kanter,Pim B Van Der Meer,Linda Dirven,Martin Klein,Geert J Lycklama À Nijeholt,Ruud G Wiggenraad

doi:10.1007/s11060-018-2868-7

Abstract

BackgroundRecently, it has been shown that at group level, patients with limited brain metastases treated with stereotactic radiotherapy (SRT) maintain their pre-treatment levels of neurocognitive functioning (NCF) and health-related quality of life (HRQoL). The aim of this study was to evaluate NCF and HRQoL changes over time at the individual patient level.MethodsNCF (seven domains assessed with a standardized test battery) and HRQoL (eight predetermined scales assessed with the EORTC QLQ-C30 and BN20 questionnaires) were measured prior to SRT and at 3 and/or 6 months follow-up. Changes in NCF and HRQoL were evaluated at (1) a domain/scale level and (2) patient level.ResultsA total of 55 patients were examined, of which the majority showed stable NCF 3 months after SRT, on both the domain level (78–100% of patients) and patient level (67% of patients). This was different for HRQoL, where deterioration in the different scales was observed in 12–61% of patients, stable scores in 20–71%, and improvement in 16–40%, 3 months after SRT. At patient level, most patients (64%) showed both improvement and deterioration in different HRQoL scales. Results were similar between 3 and 6 months after SRT.ConclusionIn line with results at group level, most brain oligometastases patients with ≥ 6 months follow-up and treated with SRT maintained their pre-treatment level of NCF during this period. By contrast, changes in HRQoL scores differed considerably at domain and patient level, despite stable HRQoL scores at group level.

Highlights

Brain metastases are a common manifestation of systemic cancer, with an estimated 9–45% of cancer patients developing brain metastases [1, 2]
The main component of stereotactic radiotherapy (SRT) is precise delivery of focal high dose radiation to a discrete target volume in 1–5 sessions, while minimizing irradiation of surrounding normal tissue [8, 14]. This treatment is useful for patients presenting with limited brain metastases [15], which is the largest subgroup of patients, considering that 70% of the patients have three or fewer metastases [16]
SRT alone is associated with better neurocognitive functioning (NCF) and health-related quality of life (HRQoL), while overall survival (OS) is comparable with Whole-brain radiotherapy (WBRT) alone or a combination of WBRT and SRT [5, 17, 18]

Summary

Introduction

Brain metastases are a common manifestation of systemic cancer, with an estimated 9–45% of cancer patients developing brain metastases [1, 2]. The main component of SRT is precise delivery of focal high dose radiation to a discrete target volume in 1–5 sessions, while minimizing irradiation of surrounding normal tissue [8, 14] This treatment is useful for patients presenting with limited brain metastases [15], which is the largest subgroup of patients, considering that 70% of the patients have three or fewer metastases [16]. It has been shown that at group level, patients with limited brain metastases treated with stereotactic radiotherapy (SRT) maintain their pre-treatment levels of neurocognitive functioning (NCF) and health-related quality of life (HRQoL). Conclusion In line with results at group level, most brain oligometastases patients with ≥ 6 months follow-up and treated with SRT maintained their pre-treatment level of NCF during this period. Changes in HRQoL scores differed considerably at domain and patient level, despite stable HRQoL scores at group level

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