scholarly journals Stereotactic Radiosurgery for Multiple Brain Metastases: Two Cases of Preserved Quality of Life

Cureus ◽  
2017 ◽  
Author(s):  
Anthony Pham ◽  
Becky Lee ◽  
Eric L Chang
Keyword(s):  
Quality Of Life ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Multiple Brain Metastases

Quality of Life following Stereotactic Radiosurgery for Single and Multiple Brain Metastases

2016 ◽  
Vol 96 (2) ◽  
pp. E536
Author(s):  
J.A. Miller ◽  
R. Kotecha ◽  
G.H. Barnett ◽  
J.H. Suh ◽  
L. Angelov ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Multiple Brain Metastases

Quality of Life following Stereotactic Radiosurgery for Single and Multiple Brain Metastases

Neurosurgery ◽  
2017 ◽  
Vol 81 (1) ◽  
pp. 147-155 ◽  
Author(s):  
Jacob A. Miller ◽  
Rupesh Kotecha ◽  
Gene H. Barnett ◽  
John H. Suh ◽  
Lilyana Angelov ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Minimum Clinically Important Difference ◽  
Clinically Important Difference ◽  
Patient Health ◽  
Appropriate Therapy

Abstract BACKGROUND: Given the neurological morbidity and poor prognosis associated with brain metastases, it is critical to deliver appropriate therapy while remaining mindful of patient quality of life (QOL). For many patients, stereotactic radiosurgery (SRS) effectively controls intracranial disease, but QOL outcomes have not been characterized. OBJECTIVE: To determine the effect of number of brain metastases upon QOL preservation following SRS. METHODS: The EuroQol 5 Dimensions questionnaire (EQ-5D) and Patient Health Questionnaire 9 instruments were prospectively collected from a cohort of patients undergoing SRS for brain metastasis between 2008 and 2015. These instruments served as measures of overall QOL and depression. QOL deterioration exceeding the minimum clinically important difference was considered failure. Freedom from 12-month EQ-5D index failure was the primary outcome. RESULTS: One hundred and twenty-two SRS treatments (67 patients, 421 lesions) were eligible for inclusion. Intracranial failure (local or distant) occurred following 61% of treatments. Among 421 lesions, 8% progressed locally. Median follow-up was 12 months. All subscores of the EQ-5D instrument expectantly worsened at last follow-up; however, the magnitude of this difference (0.079) did not exceed the EQ-5D index minimum clinically important difference (mean 0.752 vs 0.673, P < .01). Twelve-month EQ-5D index QOL preservation was 79%. Patients with more than 3 brain metastases had a greater rate of EQ-5D index deterioration (hazard ratio 4.14, P < .01) than those with a single metastasis. CONCLUSIONS: Among patients with brain metastasis, QOL preservation must remain paramount as multimodality therapy continues to improve. In the present investigation, 12-month QOL preservation was 79%. However, patients with more than 3 brain metastases were at significantly greater risk for QOL decline.

scholarly journals Quality of life outcomes for brain metastasis patients treated with stereotactic radiosurgery: pre-procedural predictive factors from a prospective national registry

2019 ◽  
Vol 131 (6) ◽  
pp. 1848-1854 ◽  
Author(s):  
Jason P. Sheehan ◽  
Inga Grills ◽  
Veronica L. Chiang ◽  
Huamei Dong ◽  
Arthur Berg ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
National Registry ◽  
Karnofsky Performance Scale ◽  
Linear Regression Models ◽  
Anxiety Depression

OBJECTIVEStereotactic radiosurgery (SRS) is increasingly used for the treatment of brain metastasis. To date, most studies have focused on survival, radiological response, or surrogate quality endpoints such as Karnofsky Performance Scale status or neurocognitive indices. The current study prospectively evaluated pre-procedural factors impacting quality of life in brain metastasis patients undergoing SRS.METHODSUsing a national, cloud-based platform, patients undergoing SRS for brain metastasis were accrued to the registry. Quality of life prior to SRS was assessed using the 5-level EQ-5D (EQ5D-L) validated tool; additionally, patient and treatment attributes were collected. Patient quality of life was assessed as part of routine follow-up after SRS. Factors predicting a difference in the aggregate EQ5D-L score or the subscores were evaluated. Pre-SRS covariates impacting changes in EQ5D-L were statistically evaluated. Statistical analyses were conducted using multivariate linear regression models.RESULTSEQ5D-L results were available for 116 patients. EQ5D-L improvement (average of 0.387) was noted in patients treated with earlier SRS (p = 0.000175). Worsening overall EQ5D-L (average of 0.052 per lesion) was associated with an increased number of brain metastases at the time of initial presentation (p = 0.0399). Male sex predicted a risk of worsening (average of 0.347) of the pain and discomfort subscore at last follow-up (p = 0.004205). Baseline subscores of pain/discomfort were not correlated with pain/discomfort subscores at follow-up (p = 0.604), whereas baseline subscores of anxiety/depression were strongly positively correlated with the anxiety/depression follow-up subscores (p = 0.0039).CONCLUSIONSAfter SRS, quality of life was likely to improve in patients treated early with SRS and worsen in those with a greater number of brain metastases. Sex differences appear to exist regarding pain and discomfort worsening after SRS. Those with high levels of anxiety and depression at SRS may benefit from medical treatment as this particular quality of life factor generally remains unchanged after SRS.

Three or More Courses of Stereotactic Radiosurgery for Patients with Multiply Recurrent Brain Metastases

Neurosurgery ◽  
2017 ◽  
Vol 80 (6) ◽  
pp. 871-879 ◽  
Author(s):  
Rupesh Kotecha ◽  
Nicholas Damico ◽  
Jacob A. Miller ◽  
John H. Suh ◽  
Erin S. Murphy ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Overall Survival ◽  
Confidence Interval ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Cox Regression ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Intracranial Recurrence

Abstract BACKGROUND: Although patients with brain metastasis are treated with primary stereotactic radiosurgery (SRS), the use of salvage therapies and their consequence remains understudied. OBJECTIVE: To study the intracranial recurrence patterns and salvage therapies for patients who underwent multiple SRS courses. METHODS: A retrospective review was performed of 59 patients with brain metastases who underwent ≥3 SRS courses for new lesions. Cox regression analyzed factors predictive for overall survival. RESULTS: The median age at diagnosis was 52 years. Over time, patients underwent a median of 3 courses of SRS (range: 3-8) to a total of 765 different brain metastases. The 6-month risk of distant intracranial recurrence after the first SRS treatment was 64% (95% confidence interval: 52%-77%). Overall survival was 40% (95% confidence interval: 28%-53%) at 24 months. Only 24 patients (41%) had a decline in their Karnofsky Performance Status ≤70 at last office visit. Quality of life was preserved among 77% of patients at 12 months, with 45% experiencing clinically significant improvement during clinical follow-up. Radiation necrosis developed in 10 patients (17%). On multivariate analysis, gender (males, Hazard Ratio [HR]: 2.0, P < .05), Karnofsky Performance Status ≤80 (HR 3.2, P < .001), extracranial metastases (HR: 3.6, P < .001), and a distant intracranial recurrence ≤3 months from initial to repeat SRS (HR: 3.8, P < .001) were associated with a poorer survival. CONCLUSION: In selected patients, performing ≥3 SRS courses controls intracranial disease. Patients may need salvage SRS for distant intracranial relapse, but focal retreatments are associated with modest toxicity, do not appear to negatively affect a patient's performance status, and help preserve quality of life.

scholarly journals Health-related quality of life of patients with brain metastases selected for stereotactic radiosurgery

2019 ◽  
Vol 143 (3) ◽  
pp. 537-546 ◽  
Author(s):  
Eline Verhaak ◽  
Karin Gehring ◽  
Patrick E. J. Hanssens ◽  
Margriet M. Sitskoorn
Keyword(s):  
Quality Of Life ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

scholarly journals Health-related quality of life in adult patients with brain metastases after stereotactic radiosurgery: a systematic, narrative review

2019 ◽  
Vol 28 (2) ◽  
pp. 473-484 ◽  
Author(s):  
Eline Verhaak ◽  
Karin Gehring ◽  
Patrick E. J. Hanssens ◽  
Neil K. Aaronson ◽  
Margriet M. Sitskoorn
Keyword(s):  
Quality Of Life ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Health Related Quality ◽  
Number Of Patients ◽  
Related Quality ◽  
Health Related ◽  
The Impact ◽  
Over Time

Abstract Purpose A growing number of patients with brain metastases (BM) are being treated with stereotactic radiosurgery (SRS), and the importance of evaluating the impact of SRS on the health-related quality of life (HRQoL) in these patients has been increasingly acknowledged. This systematic review summarizes the current knowledge about the HRQoL of patients with BM after SRS. Methods We searched EMBASE, Medline Ovid, Web-of-Science, the Cochrane Database, PsycINFO Ovid, and Google Scholar up to November 15, 2018. Studies in patients with BM in which HRQoL was assessed before and after SRS and analyzed over time were included. Studies including populations of several types of brain cancer and/or several types of treatments were included if the results for patients with BM and treatment with SRS alone were described separately. Results Out of 3638 published articles, 9 studies met the eligibility criteria and were included. In 4 out of 7 studies on group results, overall HRQoL of patients with BM remained stable after SRS. In small study samples of longer-term survivors, overall HRQoL remained stable up to 12 months post-SRS. Contradictory results were reported for physical and general/global HRQoL, which might be explained by the different questionnaires that were used. Conclusions In general, SRS does not have significant negative effects on patients’ overall HRQoL over time. Future research is needed to analyze different aspects of HRQoL, differences in individual changes in HRQoL after SRS, and factors that influence these changes. These studies should take into account several methodological issues as discussed in this review.

Quality of life in patients treated with stereotactic radiosurgery following resection of brain metastases.

2011 ◽  
Vol 29 (15_suppl) ◽  
pp. e19726-e19726
Author(s):  
C. Turner ◽  
D. Stacy ◽  
B. Collett ◽  
J. Lipani ◽  
S. Williamson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery
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