Can stereotactic radiosurgery improve life quality in patients with large brain metastasis?

Eight out of nine quality of life (QOL) metrics have improved or remained unchanged following initial stereotactic radiosurgery (SRS) in patients treated with 3-fraction SRS for large brain metastasis cavities, a phase I/II study has shown. Intracranial tumour progression and salvage SRS show no impact on QOL.

The study included patients with one to four brain metastases, of which one was a resection cavity 4.2 to 33.5 cm³. The authors obtained the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaires core-30 (QLQ-30) and brain cancer specific module (QLQ-BN20) prior to SRS and at each follow-up.

The following scales were then analysed: global health status; physical, social, and emotional functioning; motor dysfunction, communication deficit, fatigue, insomnia, and future uncertainty. Mixed effects models were used to assess QOL. Differences ≥10 points with q-value (adjusted p-value to account for multiplicity of testing) <0.10 were considered significant.

Fifty patients completed a total of 277 QOL questionnaires between 2009 and 2014. Median questionnaire follow-up was 11.8 months.

After SRS, insomnia significantly improved (q=0.032, –17.7 points at 15 months post-SRS), while future uncertainty significantly worsened (q=0.018, 9.9 points at 15 months post-SRS). No significant changes in QOL were noted following intracranial progression and salvage SRS. Due to limited data (n=4 patients), the impact of salvage whole brain radiotherapy could not be examined.

Moreover, QOL significantly got worse in three metrics (ie, physical functioning: q=0.024; emotional functioning: q=0.001; and future uncertainty: q=0.004) in 28 percent of patients who had adverse radiation effect.

“Adverse radiation effect may be associated with at least short-term QOL impairments, but [this] requires further investigation,” the authors said.