Skip to main content

Advertisement

SpringerLink
Log in

Health-related quality of life after stereotactic radiosurgery in patients with brain metastases

  • Research
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to assess health-related quality of life (HRQoL) in patients with brain metastases treated with stereotactic radiosurgery (SRS) and to identify factors associated with this.

Methods

HRQoL was measured pre-SRS, at 3- and 6-month follow-up. Physical functioning, cognitive functioning, role functioning, and fatigue were analyzed with the EORTC QLQ-C30 questionnaire. Motor dysfunction, future uncertainty, visual disorder, communication deficit, and headaches were analyzed with the EORTC QLQ-BN20. Clinically important symptom or functional impairment was assessed following set thresholds. Factors associated with impairment were identified through multivariable logistic regression analyses.

Results

At baseline, 178 patients were included; 54% (n=96) completed questionnaires at 3 months and 39% (n=70) at 6 months. Before SRS, 29% of linear accelerator (LINAC) patients reported physical and cognitive impairment, while 25% reported impairment for fatigue. At 6 months, 39%, 43%, and 57% of LINAC patients reported impairment respectively. Forty-five percent of Gamma Knife (GK) patients reported impairment pre-SRS for physical, cognitive functioning, and fatigue. At 6 months, 48%, 43%, and 33% of GK patients reported impairment respectively. Except for role functioning, pre-SRS symptom and functioning scores were associated with impairment at 3 months, whereas scores at 3 months were associated with impairment at 6 months. Age, gender, systemic therapy, and intracranial progression were not associated with clinically important impairment.

Conclusion

As 33–57% of patients with brain metastases reported symptom burden and functional impairments that were of clinical importance, it is recommended to pay attention to the HRQoL outcomes of these patients during clinical encounters.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Achrol AS, Rennert RC, Anders C, Soffietti R, Ahluwalia MS, Nayak L et al (2019) Brain metastases. Nat Rev Dis Primers 5(1):1–26

    Article  Google Scholar 

  2. Hatiboglu MA, Akdur K, Sawaya R (2020) Neurosurgical management of patients with brain metastasis. Neurosurg Rev 43(2):483–495

    Article  PubMed  Google Scholar 

  3. Fox BD, Cheung VJ, Patel AJ, Suki D, Rao G (2011) Epidemiology of metastatic brain tumors. Neurosurg Clin N Am 22(1):1–6

    Article  PubMed  Google Scholar 

  4. Dhakal S, Peterson CR 3rd, Milano MT (2014) Radiation therapy in the management of patients with limited brain metastases. Am J Clin Oncol 37(2):208–214

    Article  CAS  PubMed  Google Scholar 

  5. Rastogi K, Bhaskar S, Gupta S, Jain S, Singh D, Kumar P (2018) Palliation of brain metastases: analysis of prognostic factors affecting overall survival. Indian J Palliat Care 24(3):308–312

    PubMed  PubMed Central  Google Scholar 

  6. Soffietti R, Kocher M, Abacioglu UM, Villa S, Fauchon F, Baumert BG et al (2013) A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. J Clin Oncol 31(1):65–72

    Article  PubMed  Google Scholar 

  7. Miller JA, Kotecha R, Barnett GH, Suh JH, Angelov L, Murphy ES et al (2017) Quality of life following stereotactic radiosurgery for single and multiple brain metastases. Neurosurgery 81(1):147–155

    Article  PubMed  Google Scholar 

  8. Wong E, Zhang L, Rowbottom L, Chiu N, Chiu L, McDonald R et al (2016) Symptoms and quality of life in patients with brain metastases receiving whole-brain radiation therapy. Support Care Cancer 24(11):4747–4759

    Article  PubMed  Google Scholar 

  9. Verhaak E, Gehring K, Hanssens PEJ, Aaronson NK, Sitskoorn MM (2020) Health-related quality of life in adult patients with brain metastases after stereotactic radiosurgery: a systematic, narrative review. Support Care Cancer 28(2):473–484

    Article  PubMed  Google Scholar 

  10. Bezjak A, Adam J, Barton R, Panzarella T, Laperriere N, Wong CS et al (2002) Symptom response after palliative radiotherapy for patients with brain metastases. Eur J Cancer 38(4):487–496

    Article  CAS  PubMed  Google Scholar 

  11. Reddy NK, Brown FC, Fogarasi MC, Yu JB, Hess J, Chiang VS (2018) Long-term quality of life in survivors of brain metastases: a roller coaster of perspective. Cureus 10(3):e2358

    PubMed  PubMed Central  Google Scholar 

  12. Kepka L, Tyc-Szczepaniak D, Osowiecka K, Sprawka A, Trąbska-Kluch B, Czeremszynska B (2018) Quality of life after whole brain radiotherapy compared with radiosurgery of the tumor bed: results from a randomized trial. Clin Transl Oncol 20(2):150–159

    Article  CAS  PubMed  Google Scholar 

  13. Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K et al (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. Jama 295(21):2483–2491

    Article  CAS  PubMed  Google Scholar 

  14. Ferini G, Viola A, Valenti V, Tripoli A, Molino L, Marchese VA et al (2022) Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): a prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life. Clin Transl Radiat Oncol 32:52–58

    CAS  PubMed  Google Scholar 

  15. Verhaak E, Gehring K, Hanssens PEJ, Sitskoorn MM (2019) Health-related quality of life of patients with brain metastases selected for stereotactic radiosurgery. J Neurooncol 143(3):537–546

    Article  PubMed  PubMed Central  Google Scholar 

  16. Habets EJ, Dirven L, Wiggenraad RG, Verbeek-de Kanter A, Nijeholt GJ LÀ, Zwinkels H et al (2016) Neurocognitive functioning and health-related quality of life in patients treated with stereotactic radiotherapy for brain metastases: a prospective study. Neuro Oncol 18(3):435–444

    Article  CAS  PubMed  Google Scholar 

  17. Harikar MM, Venkataram T, Palmisciano P, Scalia G, Baldoncini M, Cardali SM et al (2023) Comparison of staged stereotactic radiosurgery and fractionated stereotactic radiotherapy in patients with brain metastases > 2 cm without prior whole brain radiotherapy: a systematic review and meta-analysis. World Neurosurg 178:213–32.e6

    Article  PubMed  Google Scholar 

  18. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376

    Article  CAS  PubMed  Google Scholar 

  19. Osoba D, Aaronson NK, Muller M, Sneeuw K, Hsu MA, Yung WK et al (1996) The development and psychometric validation of a brain cancer quality-of-life questionnaire for use in combination with general cancer-specific questionnaires. Qual Life Res 5(1):139–150

    Article  CAS  PubMed  Google Scholar 

  20. Rahimy E, Dudley SA, von Eyben R, Pollom EL, Seiger K, Modlin L et al (2021) Phase I/II dose-escalation trial of 3-fraction stereotactic radiosurgery for resection cavities from large brain metastases: health-related quality of life outcomes. Am J Clin Oncol 44(11):588–595

    Article  CAS  PubMed  Google Scholar 

  21. Sebastian NT, Glenn C, Hughes R, Raval R, Chu J, DiCostanzo D et al (2020) Linear accelerator-based radiosurgery is associated with lower incidence of radionecrosis compared with gamma knife for treatment of multiple brain metastases. Radiother Oncol 147:136–143

    Article  CAS  PubMed  Google Scholar 

  22. Tuleasca C, Negretti L, Faouzi M, Magaddino V, Gevaert T, von Elm E et al (2018) Radiosurgery in the management of brain metastasis: a retrospective single-center study comparing Gamma Knife and LINAC treatment. J Neurosurg 128(2):352–361

    Article  PubMed  Google Scholar 

  23. Giesinger JM, Loth FLC, Aaronson NK, Arraras JI, Caocci G, Efficace F et al (2020) Thresholds for clinical importance were established to improve interpretation of the EORTC QLQ-C30 in clinical practice and research. J Clin Epidemiol 118:1–8

    Article  PubMed  Google Scholar 

  24. Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S (1998) Using reference data on quality of life--the importance of adjusting for age and gender, exemplified by the EORTC QLQ-C30 (+3). Eur J Cancer 34(9):1381–1389

    Article  CAS  PubMed  Google Scholar 

  25. Nolte S, Liegl G, Petersen MA, Aaronson NK, Costantini A, Fayers PM et al (2019) General population normative data for the EORTC QLQ-C30 health-related quality of life questionnaire based on 15,386 persons across 13 European countries, Canada and the Unites States. Eur J Cancer 107:153–163

    Article  CAS  PubMed  Google Scholar 

  26. Salans M, Yip A, Burkeen J, Liu KX, Lee E, Pan-Weisz T et al (2021) Prospective longitudinal assessment of health-related quality of life in patients with brain metastases undergoing radiation therapy. Am J Clin Oncol 44(10):536–543

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. van der Meer PB, Habets EJJ, Wiggenraad RG, Verbeek-de Kanter A, Nijeholt GJ LÀ, Zwinkels H et al (2018) Individual changes in neurocognitive functioning and health-related quality of life in patients with brain oligometastases treated with stereotactic radiotherapy. J Neurooncol 139(2):359–368

    Article  PubMed  PubMed Central  Google Scholar 

  28. Qiu X, Zhang N, Pan SJ, Zhao P, Wu BW (2020) Sense of coherence and health-related quality of life in patients with brain metastases. Front Psychol 11:1516

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sprangers MA (1996) Response-shift bias: a challenge to the assessment of patients’ quality of life in cancer clinical trials. Cancer Treat Rev 22(Suppl A):55–62

    Article  PubMed  Google Scholar 

  30. Lin NU, Wefel JS, Lee EQ, Schiff D, van den Bent MJ, Soffietti R et al (2013) Challenges relating to solid tumour brain metastases in clinical trials, part 2: neurocognitive, neurological, and quality-of-life outcomes. A report from the RANO group. Lancet Oncol 14(10):e407–e416

    Article  PubMed  Google Scholar 

  31. Skeie BS, Eide GE, Flatebø M, Heggdal JI, Larsen E, Bragstad S et al (2017) Quality of life is maintained using Gamma Knife radiosurgery: a prospective study of a brain metastases patient cohort. J Neurosurg 126(3):708–725

    Article  PubMed  Google Scholar 

  32. Caissie A, Nguyen J, Chen E, Zhang L, Sahgal A, Clemons M et al (2012) Quality of life in patients with brain metastases using the EORTC QLQ-BN20+2 and QLQ-C15-PAL. Int J Radiat Oncol Biol Phys 83(4):1238–1245

    Article  PubMed  Google Scholar 

  33. Snyder C, Brundage M, Rivera YM, Wu AW. A PRO-cision medicine methods toolkit to address the challenges of personalizing cancer care using patient-reported outcomes: introduction to the supplement. Med Care. 2019;57 Suppl 5 Suppl 1(Suppl 5 1):S1-s7.

Download references

Funding

The study was funded by the Netherlands Cancer Institute.

Author information

Authors and Affiliations

  1. Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands

    Elaine A.C. Albers, Kelly M. de Ligt, Lonneke V. van de Poll-Franse, Michiel B. de Ruiter & Sanne B. Schagen

  2. Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands

    Lonneke V. van de Poll-Franse

  3. Department of Medical and Clinical Psychology, Center of Research On Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands

    Lonneke V. van de Poll-Franse

  4. Department of neuro-oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Annette Compter

  5. Deparment of Psychology, University of Amsterdam, Amsterdam, The Netherlands

    Sanne B. Schagen

Authors
  1. Elaine A.C. Albers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kelly M. de Ligt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lonneke V. van de Poll-Franse
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Annette Compter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michiel B. de Ruiter
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sanne B. Schagen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MR and SS contributed to the study conception and design, material preparation, and data collection. Analyses were performed by EA. Clinical characteristic information was retrieved by EA and AC. The first draft of the manuscript was written by EA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Elaine A.C. Albers.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the local Institutional Review Board of the Dutch Cancer Institute (IRBd20-089).

Consent to participate

Informed consent was obtained from all individual participants included in this study.

Consent to publish

The authors affirm that all human research participants provided informed consent for publication of their data.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 537 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Albers, E.A., de Ligt, K.M., van de Poll-Franse, L.V. et al. Health-related quality of life after stereotactic radiosurgery in patients with brain metastases. Support Care Cancer 31, 720 (2023). https://doi.org/10.1007/s00520-023-08203-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-023-08203-6

Keywords

Search

Navigation