Background:
Prospective data on quality-of-life (QoL) effects of radiotherapy for brain metastases are currently lacking, but would be of great interest to guide therapeutic decisions.
Patients and Methods:
From 01/2007 to 08/2007, 46 patients with previously untreated brain metastases were recruited at eight centers. QoL was measured at start of treatment (T0) and at 3 months (T3mo). In the pilot study, two combinations of QoL instruments could be used at the discretion of the centers (A: EORTC QLQ-C30 and B: EORTC QLQ-C15-PAL both with brain module BN20, assessment by proxies with A: Palliative Care Outcome Scale, B: self-constructed brain-specific instrument).
Results:
All patients received whole-brain radiotherapy, four with an additional boost irradiation. At T3mo, 26/46 patients (56.5%) had died. 17/20 survivors (85%) completed the questionnaires. In 3-month survivors, QoL deteriorated in most domains, significant in drowsiness, hair loss and weakness of legs. The scores for headaches and seizures were slightly better after 3 months. Assessment by proxies also suggested worsening of QoL. Initial QoL at T0 was better in those alive than in those deceased at T3mo, significant for physical function and for the symptom scales of fatigue and pain, motor dysfunction, communication deficit and weakness of legs.
Conclusion:
Practicability and compliance appeared better with the (shorter) version B. This version is now used in the ongoing main phase of the study with additional centers. First results indicate a moderate worsening of QoL during the first 3 months after start of palliative radiotherapy for brain metastases. QoL at initiation of radiotherapy may be prognostic for survival.
Hintergrund:
Prospektive Daten über die Auswirkung einer palliativen Strahlentherapie auf die Lebensqualität (LQ) von Patienten mit Hirnmetastasen existieren nur wenige, jedoch sind sie von großem Interesse für Therapieentscheidungen.
Patienten und Methodik:
Von 01/2007 bis 08/2007 wurden an acht Zentren 46 Patienten mit bisher unbehandelten Hirnmetastasen rekrutiert (Tabelle 1). Die LQ vor und 3 Monate nach palliativer Strahlentherapie wurde erhoben. In der Pilotphase konnten die Zentren zwischen zwei Kombinationen von Instrumenten wählen (A: EORTC QLQ-C30 und B: QLQ C15-PAL jeweils mit Hirnmodul BN20, Fremdeinschätzung durch Angehörige mittels A: Palliative Care Outcome Scale, B: eigenen Hirnmoduls).
Ergebnisse:
Alle Patienten erhielten eine Ganzhirnbestrahlung, vier Patienten zusätzlich eine Boostbestrahlung. 3 Monate nach Therapiebeginn waren 26/46 Patienten (56,5%) verstorben. Die Rücklaufquote der Fragebögen der Überlebenden betrug 17/20 (85%). Für dieses Kollektiv der 3-Monats-Überlebenden zeigte die Selbsteinschätzung eine Verschlechterung in den meisten Bereichen, signifikant für Schläfrigkeit, Alopezie und Beinschwäche. Die Scores für Kopfschmerzen und Krampfleiden waren nach 3 Monaten etwas besser (Abbildung 1). Die Fremdeinschätzungen zeigten ebenfalls eine zunehmende Beeinträchtigung der Patienten nach 3 Monaten (Abbildung 2). Die initiale LQ war bei den 3-Monats-Überlebenden (Abbildung 3a) im Vergleich zu den Verstorbenen besser, signifikant für die körperliche Funktion und für die Symptomskalen Fatigue, Schmerz (Abbildung 3b), motorische Dysfunktion, Kommunikationsdefizit und Beinschwäche (Abbildung 3c).
Schlussfolgerung:
Die kürzere Fragebogenvariante B schien bezüglich der Praktikabilität und Compliance besser zu sein. Demzufolge wird diese Variante in der aktuell laufenden Hauptphase mit zusätzlichen Zentren verwendet (Abbildung 4). Erste Ergebnisse deuten auf eine mäßige LQ-Verschlechterung bei 3-Monats-Überlebenden hin. Möglicherweise könnte die initiale objektivierte LQ als prädiktiver Faktor herangezogen werden.
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References
Aaronson NK, Ahmedzai S, Bergman B, et al. 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 1993;85:365–76.
Bausewein C, Fegg M, Radbruch L, et al. Validation and clinical application of the German version of the Palliative Care Outcome Scale. J Pain Symptom Manage 2005;30:51–62.
Bezjak A, Adam J, Barton R, et al. Symptom response after palliative radiotherapy for patients with brain metastases. Eur J Cancer 2002;38:487–96.
Brown PD, Asher AL, Farace E. Adjuvant whole brain radiotherapy: strong emotions decide but rational studies are needed. Int J Radiat Oncol Biol Phys 2008;70:1305–9.
Corn BW, Moughan J, Knisely JP, et al. Prospective evaluation of quality of life and neurocognitive effects in patients with multiple brain metastases receiving whole-brain radiotherapy with or without thalidomide on Radiation Therapy Oncology Group (RTOG) trial 0118. Int J Radiat Oncol Biol Phys 2008;71:71–8.
DiBiase SJ, Chin LS, Ma L. Influence of gamma knife radiosurgery on the quality of life in patients with brain metastases. Am J Clin Oncol 2002;25:131–4.
Doyle M, Bradley NM, Li K, et al. Quality of life in patients with brain metastases treated with a palliative course of whole-brain radiotherapy. J Palliat Med 2007;10:367–74.
Fahrig A, Ganslandt O, Lambrecht U, et al. Hypofractionated stereotactic radiotherapy for brain metastases. Results from three different dose concepts. Strahlenther Onkol 2007;183:625–30.
Fayers PM. Interpreting quality of life data: population-based reference data for the EORTC QLQ-C30. Eur J Cancer 2001;37:1331–4.
Gaspar L, Scott C, Rotman M, et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 1997;37:745–51.
Groenvold M, Petersen MA, Aaronson NK, et al., EORTC Quality of Life Group. The development of the EORTC QLQ-C15-PAL: a shortened questionnaire for cancer patients in palliative care. Eur J Cancer 2006;42:55–64.
Klein M, Postma TJ, Taphoorn MJ, et al. The prognostic value of cognitive functioning in the survival of patients with high-grade glioma. Neurology 2003;61:1796–8.
Kramer JA, Curran D, Piccart M, et al. Identification and interpretation of clinical and quality of life prognostic factors for survival and response to treatment in first-line chemotherapy in advanced breast cancer. Eur J Cancer 2000;36:1498–506.
Li J, Bentzen SM, Renschler M, et al. Regression after whole-brain radiation therapy for brain metastases correlates with survival and improved neurocognitive function. J Clin Oncol 2007;25:1260–6.
Mauer ME, Taphoorn MJ, Bottomley A, et al., EORTC Brain Cancer Group. Prognostic value of health-related quality-of-life data in predicting survival in patients with anaplastic oligodendrogliomas, from a phase III EORTC Brain Cancer Group study. J Clin Oncol 2007;25:5731–7.
Meyers CA, Hess KR, Yung WK, et al. Cognitive function as a predictor of survival in patients with recurrent malignant glioma. J Clin Oncol 2000;18:646–50.
Nieder C, Astner ST, Grosu AL, et al. The role of postoperative radiotherapy after resection of a single brain metastasis. Combined analysis of 643 patients. Strahlenther Onkol 2007;183:576–80.
Rades D, Bohlen G, Dunst J, et al. Comparison of short-course versus long-course whole-brain radiotherapy in the treatment of brain metastases. Strahlenther Onkol 2008;184:30–5.
Rades D, Bohlen G, Lohynska R, et al. Whole-brain radiotherapy with 20 Gy in 5 fractions for brain metastases in patients with cancer of unknown primary (CUP). Strahlenther Onkol 2007;183:631–6.
Sehlen S, Lenk M, Hollenhorst H, et al. Quality of life (QoL) as predictive mediator variable for survival in patients with intracerebral neoplasma during radiotherapy. Onkologie 2003;26:38–43.
Velikova G, Booth L, Smith AB, et al. Measuring quality of life in routine oncology practice improves communication and patient well-being: A randomized controlled trial. J Clin Oncol 2004;22:714–24.
Vordermark D. Avoiding bias in the prospective evaluation of patients with brain metastases. J Clin Oncol 2007;25:4023, author reply 4024–5.
Weissman DE. Glucocorticoid treatment for brain metastases and epidural spinal cord compression: a review. J Clin Oncol 1988;6:543–51.
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Steinmann, D., Schäfer, C., van Oorschot, B. et al. Effects of Radiotherapy for Brain Metastases on Quality of Life (QoL). Strahlenther Onkol 185, 190–197 (2009). https://doi.org/10.1007/s00066-009-1904-0
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DOI: https://doi.org/10.1007/s00066-009-1904-0