title: Radiosurgery with or without whole-brain radiotherapy for brain metastases: the patients' perspective regarding complications.
abstract: BACKGROUND
  When cancer spreads to the brain, patients and their families report a much reduced quality of life. Whole-brain radiation therapy (WBRT) and/or radiosurgery (RS) are mainstays of management for patients with metastatic brain cancer. Despite the ubiquity of this problem, little is known about the patients' perspective regarding management-related complications. To assess the patients' perspective regarding current therapeutic options, we retrospectively surveyed 200 consecutive patients who underwent radiosurgery with or without WBRT.
  
  
  METHODS
  The survey consisted of 10 questions that sought information on quality of life, employment status, side effects (hair loss, fatigue, memory, concentration, mood, or employment), activity level, and satisfaction.
  
  
  RESULTS
  We tabulated 104 responses (52%). WBRT was used in 69% (72 of 104); all patients had radiosurgery. After WBRT, the following were noted: hair loss (88%; total regrowth in 24%), excess fatigue (95%), problems with short-term memory (72%), long-term memory (33%), concentration (61%), and depression (54%). Sixty-three percent of patients who had WBRT thought they had side effects after treatment compared with 34% who had radiosurgery only (P <0.001). Only 5% of RS patients reported fatigue. Seventy-six percent and 56% of respondents considered RS or WBRT, respectively, a good treatment of them (P = 0.25). Only 26 patients (27%) were employed at the time of treatment and 16 remained employed (62%). Eighteen percent believed that WBRT delayed other cancer treatments.
  
  
  CONCLUSIONS
  Patients with brain metastases often report complications of their disease or its treatment. Side effects are most pronounced in those who received WBRT. Radiosurgery had fewer reported side effects and was believed by more patients or families to be effective. Further study of clinical outcomes and quality of life is important to guide our management of patients with these common brain tumors.
authors.affiliation: Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. kondziolkads@upmc.edu
authors.forename: Douglas
authors.initials: D
authors.lastname: Kondziolka
authors.forename: Ajay
authors.initials: A
authors.lastname: Niranjan
authors.forename: John C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: L Dade
authors.initials: LD
authors.lastname: Lunsford
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D016371:Cranial Irradiation; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D016634:Radiosurgery; D012189:Retrospective Studies; D011795:Surveys and Questionnaires