Clinical Investigation
Quality of Life After Stereotactic Body Radiation Therapy for Primary and Metastatic Liver Tumors

https://doi.org/10.1016/j.ijrobp.2007.08.058Get rights and content

Purpose

Stereotactic body radiation therapy (SBRT) provides a high local control rate for primary and metastatic liver tumors. The aim of this study is to assess the impact of this treatment on the patient's quality of life. This is the first report of quality of life associated with liver SBRT.

Methods and Materials

From October 2002 to March 2007, a total of 28 patients not suitable for other local treatments and with Karnofsky performance status of at least 80% were entered in a Phase I–II study of SBRT for liver tumors. Quality of life was a secondary end point. Two generic quality of life instruments were investigated, EuroQol-5D (EQ-5D) and EuroQoL-Visual Analogue Scale (EQ-5D VAS), in addition to a disease-specific questionnaire, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ C-30). Points of measurement were directly before and 1, 3, and 6 months after treatment. Mean scores and SDs were calculated. Statistical analysis was performed using paired-samples t-test and Student t-test.

Results

The calculated EQ-5D index, EQ-5D VAS and QLQ C-30 global health status showed that mean quality of life of the patient group was not significantly influenced by treatment with SBRT; if anything, a tendency toward improvement was found.

Conclusions

Stereotactic body radiation therapy combines a high local control rate, by delivering a high dose per fraction, with no significant change in quality of life. Multicenter studies including larger numbers of patients are recommended and under development.

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.

References (18)

There are more references available in the full text version of this article.

Cited by (77)

  • Curative Irradiation Treatment of Hepatocellular Carcinoma: A Multicenter Phase 2 Trial

    2020, International Journal of Radiation Oncology Biology Physics
View all citing articles on Scopus

Conflict of interest: none.

View full text