title: Assessment of function and quality of life in a phase II multi-institutional clinical trial of fractionated simultaneous in-field boost radiotherapy for patients with 1-3 metastases.
abstract: We examined functional outcomes and quality of life of whole brain radiotherapy (WBRT) with integrated fractionated stereotactic radiotherapy boost (FSRT) for brain metastases treatment. Eighty seven people with 1-3 brain metastases (54/87 lung primary, 42/87 single brain metastases) were enrolled on this Phase II trial of WBRT (30 Gy/10) + simultaneous FSRT, (60 Gy/10). Median overall follow-up and survival was 5.4 months, 6 month actuarial intra-lesional control was 78 %; only 1 patient exhibited grade 4 toxicity (worsened seizures); most treatment related toxicity was grade 1 or 2; 2/87 patients demonstrated asymptomatic radiation necrosis on follow-up imaging. Mean (Min-Max) baseline KPS, Mini Mental Status Exam (MMSE) and FACT-BR quality of life were 83 (70-100), 28 (21-30) and 143 (98-153). Lower baseline MMSE (but not KPS or FACT-Br) was associated with worse survival after adjusting for age, number of metastases, primary and extra-cranial disease status. Crude rates of deterioration (>10 points decrease from baseline for KPS and FACT-Br, MMSE fall to <27) ranged from 26 to 38 % for KPS, 32-59 % for FACT-Br and 0-16 % for MMSE depending on the time-point assessed with higher rates generally noted at earlier time points (≤6 months post-treatment). Using a linear mixed models analysis, significant declines from baseline were noted for KPS and FACT-Br (largest effects at 6 weeks to 3 months) with no significant change in MMSE. The effects on function and quality of life of this integrated treatment of WBRT + simultaneous FSRT were similar to other published series combining WBRT + radiosurgery.
authors.affiliation: Division of Radiation Oncology, London Health Sciences Centre, A4-901B, 790 Commissioners Rd. E, London, ON, N6A4L6, Canada. glenn.bauman@lhsc.on.ca.
authors.forename: Glenn
authors.initials: G
authors.lastname: Bauman
authors.affiliation: Division of Radiation Oncology, London Health Sciences Centre, A4-901B, 790 Commissioners Rd. E, London, ON, N6A4L6, Canada.
authors.forename: Slav
authors.initials: S
authors.lastname: Yartsev
authors.affiliation: Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Roberge
authors.affiliation: Division of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: MacRae
authors.affiliation: Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada.
authors.forename: Wilson
authors.initials: W
authors.lastname: Roa
authors.affiliation: Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Valerie
authors.initials: V
authors.lastname: Panet-Raymond
authors.affiliation: Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Masucci
authors.affiliation: Division of Radiation Oncology, London Health Sciences Centre, A4-901B, 790 Commissioners Rd. E, London, ON, N6A4L6, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Yaremko
authors.affiliation: Division of Radiation Oncology, London Health Sciences Centre, A4-901B, 790 Commissioners Rd. E, London, ON, N6A4L6, Canada.
authors.forename: David
authors.initials: D
authors.lastname: D'Souza
authors.affiliation: Division of Radiation Oncology, London Health Sciences Centre, A4-901B, 790 Commissioners Rd. E, London, ON, N6A4L6, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Palma
authors.affiliation: Division of Radiation Oncology, London Health Sciences Centre, A4-901B, 790 Commissioners Rd. E, London, ON, N6A4L6, Canada.
authors.forename: Tracy
authors.initials: T
authors.lastname: Sexton
authors.affiliation: Division of Radiation Oncology, London Health Sciences Centre, A4-901B, 790 Commissioners Rd. E, London, ON, N6A4L6, Canada.
authors.forename: Edward
authors.initials: E
authors.lastname: Yu
authors.affiliation: Division of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Pantarotto
authors.affiliation: Division of Radiation Oncology, London Health Sciences Centre, A4-901B, 790 Commissioners Rd. E, London, ON, N6A4L6, Canada.
authors.forename: Belal
authors.initials: B
authors.lastname: Ahmad
authors.affiliation: Division of Radiation Oncology, London Health Sciences Centre, A4-901B, 790 Commissioners Rd. E, London, ON, N6A4L6, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Fisher
authors.affiliation: Division of Radiation Oncology, London Health Sciences Centre, A4-901B, 790 Commissioners Rd. E, London, ON, N6A4L6, Canada.
authors.forename: A Rashid
authors.initials: AR
authors.lastname: Dar
authors.affiliation: Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors.forename: Carole
authors.initials: C
authors.lastname: Lambert
authors.affiliation: Department of Oncology, Department of Oncology, McMaster University, Hamilton, ON, Canada.
authors.forename: Gregory
authors.initials: G
authors.lastname: Pond
authors.affiliation: Division of Radiation Oncology, London Health Sciences Centre, A4-901B, 790 Commissioners Rd. E, London, ON, N6A4L6, Canada.
authors.forename: Larry
authors.initials: L
authors.lastname: Stitt
authors.affiliation: Department of Diagnostic Radiology, London Health Sciences Centre, London, ON, Canada.
authors.forename: Keng Yeow
authors.initials: KY
authors.lastname: Tay
authors.affiliation: Division of Radiation Oncology, London Health Sciences Centre, A4-901B, 790 Commissioners Rd. E, London, ON, N6A4L6, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Rodrigues
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods; D054063:Superior Sagittal Sinus; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brain metastases; Phase II Trial; Stereotactic radiotherapy