Health-related quality of life after Gamma Knife radiosurgery in patients with 1-10 brain metastases

Eline Verhaak, Wietske C M Schimmel, Karin Gehring, Wilco H M Emons, Patrick E J Hanssens, Margriet M Sitskoorn, Eline Verhaak, Wietske C M Schimmel, Karin Gehring, Wilco H M Emons, Patrick E J Hanssens, Margriet M Sitskoorn

Abstract

Purpose: Increasingly more patients with multiple (> 4) brain metastases (BM) are being treated with stereotactic radiosurgery (SRS). Preserving patients' health-related quality of life (HRQoL) is an important treatment goal. The aim of this study was to assess (individual) changes in HRQoL in patients with 1-10 BM over time.

Methods: A total of 92 patients were assessed before (n = 92) and at 3 (n = 66), 6 (n = 53), and 9 (n = 41) months after Gamma Knife radiosurgery (GKRS), using the Functional Assessment of Cancer Therapy-Brain (FACT-Br). The course of HRQoL was analyzed using linear mixed models. Clinical minimally important differences were used to evaluate individual changes.

Results: At group level, patients' physical well-being worsened, whereas emotional well-being improved over 9 months. Scores on other HRQoL subscales did not change significantly. Number (1-3 versus 4-10) and volume (small, medium, and large) of BM did not influence HRQoL over time, except for the subscale additional concerns; medium intracranial tumor volume was associated with less additional concerns. On the individual level as well, physical well-being declined while emotional well-being improved in most patients over 9 months after GKRS. At patient level, however, most patients had both declines as well as improvements in the different HRQoL aspects.

Conclusion: Our results indicate that even in patients with up to 10 BM, both at group and individual subscale level, aspects of HRQoL remained stable over nine months after GKRS, except for an improvement in emotional well-being and a decline in physical well-being. Nevertheless, HRQoL scores varied considerably at the individual patient level.

Trail registration number: ClinicalTrials.gov Identifier: NCT02953756, November 3, 2016.

Keywords: Brain metastases; Gamma Knife radiosurgery; Health-related quality of life; Stereotactic radiosurgery.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Clinically meaningful changes in HRQoL in patients with BM from baseline to 9 months after GKRS at subscale level. BM brain metastases, FACT-G Functional Assessment of Cancer Therapy-General, GKRS Gamma Knife radiosurgery, HRQoL health-related quality of life, WB well-being. The number of patients = 41
Fig. 2
Fig. 2
Clinically meaningful changes in HRQoL in patients with BM after GKRS at patient level. BM brain metastases, GKRS Gamma Knife radiosurgery, HRQoL health-related quality of life, n number of patients. n = 41 for 0–9 months and 6–9 months, n = 66 for 0–3 months, n = 53 for 3–6 months

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