Prospective evaluation of quality of life effects in patients undergoing palliative radiotherapy for brain metastases.
BACKGROUND
Recently published results of quality of life (QoL) studies indicated different outcomes of palliative radiotherapy for brain metastases. This prospective multi-center QoL study of patients with brain metastases was designed to investigate which QoL domains improve or worsen after palliative radiotherapy and which might provide prognostic information.


METHODS
From 01/2007-01/2009, n=151 patients with previously untreated brain metastases were recruited at 14 centers in Germany and Austria. Most patients (82 %) received whole-brain radiotherapy. QoL was measured with the EORTC-QLQ-C15-PAL and brain module BN20 before the start of radiotherapy and after 3 months.


RESULTS
At 3 months, 88/142 (62 %) survived. Nine patients were not able to be followed up. 62 patients (70.5 % of 3-month survivors) completed the second set of questionnaires. Three months after the start of radiotherapy QoL deteriorated significantly in the areas of global QoL, physical function, fatigue, nausea, pain, appetite loss, hair loss, drowsiness, motor dysfunction, communication deficit and weakness of legs. Although the use of corticosteroid at 3 months could be reduced compared to pre-treatment (63 % vs. 37 %), the score for headaches remained stable. Initial QoL at the start of treatment was better in those alive than in those deceased at 3 months, significantly for physical function, motor dysfunction and the symptom scales fatigue, pain, appetite loss and weakness of legs. In a multivariate model, lower Karnofsky performance score, higher age and higher pain ratings before radiotherapy were prognostic of 3-month survival.


CONCLUSIONS
Moderate deterioration in several QoL domains was predominantly observed three months after start of palliative radiotherapy for brain metastases. Future studies will need to address the individual subjective benefit or burden from such treatment. Baseline QoL scores before palliative radiotherapy for brain metastases may contain prognostic information.
Radiation Oncology, Medical School Hannover, Hannover, Germany. Steinmann.Diana@mh-hannover.de
Diana
D
Steinmann
Yvonne
Y
Paelecke-Habermann
Hans
H
Geinitz
Raimund
R
Aschoff
Anja
A
Bayerl
Tobias
T
Bölling
Elisabeth
E
Bosch
Frank
F
Bruns
Ute
U
Eichenseder-Seiss
Johanna
J
Gerstein
Nadine
N
Gharbi
Juliane
J
Hagg
Matthias
M
Hipp
Irmgard
I
Kleff
Axel
A
Müller
Christof
C
Schäfer
Ursula
U
Schleicher
Susanne
S
Sehlen
Marilena
M
Theodorou
Hans-Joachim
HJ
Wypior
Franz
F
Zehentmayr
Birgitt
B
van Oorschot
Dirk
D
Vordermark
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires