International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationQuality of Life After Stereotactic Body Radiation Therapy for Primary and Metastatic Liver Tumors
Introduction
Clinical studies on the effect of stereotactic body radiation therapy (SBRT) included local control, survival, and toxicity. However, this outcome did not measure the influence of the treatment on the quality of life of the patients. Quality of life is an important health parameter and provides useful information to clinicians and patients about the impact of a treatment on health status. SBRT is an emerging local treatment option for patients with intrahepatic malignancies not eligible for surgery or radiofrequency ablation (RFA). Several reports showed high local control rates with acceptable toxicity associated with this treatment 1, 2, 3, 4. To achieve these favorable local response rates, high radiation doses in a small number of fractions are delivered. Application of high-precision patient positioning (rigid) and control of respiratory liver motion 5, 6, 7 may have an impact on the patient's well-being during the treatment and on the subsequent quality-of-life evaluation.
The aim of the present study is to assess, prospectively, the impact of SBRT on the quality of life of patients with primary and metastatic liver tumors. To our knowledge, this is the first report of quality of life associated with hypofractionated stereotactic liver treatments.
Section snippets
Patient characteristics
From October 2002 to March 2007, a total of 28 patients were entered in a Phase I–II study of SBRT for liver tumors, approved by the Ethical Commission of Erasmus MC and in accordance with the Declaration of Helsinki. All patients gave their written consent. Results on local control, survival, and toxicity were reported recently (3). Quality-of-life assessment was a secondary end point of this study. Patients included were those with a diagnosis of liver metastases or hepatocellular carcinoma
Data collection
Twenty-eight treated patients were considered candidates to be included in this study. One patient with residence outside The Netherlands was excluded because of lack of adequate follow-up. In addition, 1 patient did not want to participate in the study. From the remaining 26 patients, 25 pretreatment forms were submitted. One questionnaire was missing.
One month after treatment, 1 patient died (possibly treatment-related death) and 1 patient did not return the form (missing). From 25 patients
Discussion
Stereotactic body radiation therapy applied to primary and metastatic liver tumors showed a high local control rate. Our aim is to investigate whether this positive effect was achieved without quality-of-life impairment. Our results show that quality of life did not deteriorate despite the delivered high-fraction doses.
Based on the health-related quality-of-life conceptual model proposed by Wilson and Cleary (8), we analyzed quality of life at several levels: general health perceptions,
Conclusions
Data from this study show that apart from the high local control rate, SBRT was also associated with constant quality of life, maintaining the pretreatment level in the 6 months after the treatment period. Obviously, despite the delivered high doses, there was no posttreatment decrease in quality of life related to unavoidable exposure of healthy tissues. Possibly, the obtained local control resulting from the high doses may even prevent a decrease in quality of life. Currently, in Europe, a
Acknowledgments
The authors thank Elly Stolk, Ph.D., and Rob A. de Man, M.D., Ph.D., for their valuable contributions.
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Conflict of interest: none.