Quality of Life in Brain Metastases Radiation Trials: A Literature Review

Abstract

BackgroundAn estimated 20%-40% of cancer patients will develop brain metastases. Whole-brain radiotherapy (WBRT) is the standard treatment for patients with brain metastases. Although WBRT can reduce neurologic symptoms, the median survival following WBRT is between 3 and 6 months. Given this limited survival, it is important to consider quality of life (QOL) when treating patients with brain metastases. However, few studies have focused on QOL and improvement in patient-rated symptoms as primary outcomes. ObjectiveFor an accurate measurement of the extent to which previous trials have utilized QOL tools to evaluate the efficacy of WBRT for treatment of brain metastases, we undertook a literature review to examine the common endpoints and QOL instruments used. MethodsWe conducted a systematic search using the MEDLINE (1950( to December 2007 and Cochrane Central Register of Controlled Trials (4th quarter 2007) databases. Eligible studies investigated WBRT in one of the study arms. The following outcomes were included: median survival, overall survival, neurologic function, 1-year local control, and overall response; use of QOL instruments, performance status scales, and neurologic function assessments; and use of other assessment tools. Patient-rated QOL instruments were defined as those that strove to assess all dimensions of QOL; observerrated performance instruments such as the Karnofsky performance status (KPS) were deemed to be performance scales. ResultsWe identified sixty-one trials that included WBRT nine evaluated the treatment of a single brain metastasis, and fifty-two evaluated the treatment of multiple brain metastases. Although fifty-five of the trials employed a QOL instrument, few trials focused on QOL as an outcome. We found 23 different instruments used to evaluate QOL. The most commonly employed instrument was the KPS (n = 33), followed by various neurologic function classification scales (n = 21). A preponderance of the studies used 1 (n = 26, 43%) or 2 (n = 21, 34%) QOL instruments.A total of fourteen published trials on brain metastases included an evaluation of the study population's QOL. Those trials included three that used the Functional Assessment of Cancer Therapy-General scale and Brain subscale instrument, three that used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (C30) and the Brain Cancer Module 20 instrument, two that used study-designed QOL instruments, one that used the Edmonton Symptom Assessment Scale, two that used the Spitzer Quality of Life index, and three that used the KPS to evaluate QOL. Some trials reported deterioration in QOL after WBRT in patients with poorer prognosis; other trials detected an improvement in QOL after WBRT in patients with better prognosis. ConclusionsTo date, fourteen trials in brain metastases that have included an evaluation of the study population's QOL have been published. Although some studies showed that certain parameters of QOL deteriorate after WBRT, other studies showed that Q...

Cerebral gliomas: Treatment, prognosis and palliative alternatives

“…These findings are supported by other evaluations that show a larger difference in cognitive function versus quality of life following radiotherapy [37]. Despite these findings, it is argued that there are limitations in the instruments used to assess quality of life in patients affected by brain cancer [38]. Realistically, it is unlikely that any screening questionnaire will ever completely uncover the psychosocial elements that impact the lives of patients affected by glial cancers.…”

Prognostic value of pre- and post-treatment health-related quality of life in predicting survival of patients with brain metastases

“…For the majority of patients with multiple brain metastases, whom often have poor performance status, median survival is 3-6 months following treatment [4]. As such, treatment goals are focused on symptom management and maintenance of health-related quality of life (HRQOL) [4][5][6], a multidimensional concept that includes health, social and emotional wellbeing, cognition, role functioning, sexual functioning, physical functioning and symptoms and spirituality [7].…”

The Surgical Management of Brain Metastases in Non-Small Cell Lung Cancer (NSCLC): Identification of the Early Laboratory and Clinical Determinants of Survival

“…Progress in the treatment of extracranial disease has led to a more aggressive approach also in the treatment of BM [6,7]. Although there is still no curative treatment, the main purpose of the interdisciplinary treatment of BM is to achieve prolonged, highquality survival [8,9]. Neurosurgical management has to contribute to this goal with improved preoperative patient selection, intraoperative techniques and monitoring as well as postoperative complication management and patient guidance [10].…”