Abstract
BackgroundRecently published results of quality of life (QoL) studies indicated different outcomes of palliative radiotherapy for brain metastases. This prospective multi-center QoL study of patients with brain metastases was designed to investigate which QoL domains improve or worsen after palliative radiotherapy and which might provide prognostic information.MethodsFrom 01/2007-01/2009, n=151 patients with previously untreated brain metastases were recruited at 14 centers in Germany and Austria. Most patients (82 %) received whole-brain radiotherapy. QoL was measured with the EORTC-QLQ-C15-PAL and brain module BN20 before the start of radiotherapy and after 3 months.ResultsAt 3 months, 88/142 (62 %) survived. Nine patients were not able to be followed up. 62 patients (70.5 % of 3-month survivors) completed the second set of questionnaires. Three months after the start of radiotherapy QoL deteriorated significantly in the areas of global QoL, physical function, fatigue, nausea, pain, appetite loss, hair loss, drowsiness, motor dysfunction, communication deficit and weakness of legs. Although the use of corticosteroid at 3 months could be reduced compared to pre-treatment (63 % vs. 37 %), the score for headaches remained stable. Initial QoL at the start of treatment was better in those alive than in those deceased at 3 months, significantly for physical function, motor dysfunction and the symptom scales fatigue, pain, appetite loss and weakness of legs. In a multivariate model, lower Karnofsky performance score, higher age and higher pain ratings before radiotherapy were prognostic of 3-month survival.ConclusionsModerate deterioration in several QoL domains was predominantly observed three months after start of palliative radiotherapy for brain metastases. Future studies will need to address the individual subjective benefit or burden from such treatment. Baseline QoL scores before palliative radiotherapy for brain metastases may contain prognostic information.
Highlights
Published results of quality of life (QoL) studies indicated different outcomes of palliative radiotherapy for brain metastases
They suggested an approach in which more favourable patients could be treated with longer-course whole-brain radiotherapy (WBRT) to reduce neurotoxicity and other patients with poor prognosis could benefit from shortcourse WBRT
Patients and treatment characteristics Including patients of the pilot study (n = 64) [1] 151 patients with previously untreated brain metastases were recruited at 14 centres in Germany and Austria from 01/ 07 to 01/09
Summary
Published results of quality of life (QoL) studies indicated different outcomes of palliative radiotherapy for brain metastases. Differences may have been caused by diverse points of time of assessment and the variety of fractionation schemes and patient cohorts These results led us to address prospectively the question of the development of QoL over time within three months after initiation of palliative radiotherapy for brain metastases. Rades et al published a new scoring system to predict the survival of these patients treated with WBRT [11] and added the interval from tumour diagnosis to WBRT (longer time is better) to the criteria of RPA.
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