QOL preservation in patients with terminal illnesses, such as brain metastasis, must remain paramount as healthcare technology continues to progress. In the present investigation, 72% of patients maintained their QOL following GKRS, with 24% of patients experiencing clinically significant improvement.
Jacob A. Miller, BS, Rupesh Kotecha, Gene Barnett, MD, John H. Suh, MD, Lilyana Angelov, MD, Erin Murphy, MD, Michael Vogelbaum, MD, Alireza Mohammadi, MD, Samuel T. Chao, MD; Cleveland Clinic Foundation
INTRODUCTION: The median survival following metastasis to the brain is less than 10 months; 10% to 20% of all cancer patients suffer from such metastases, highlighting the significance of quality-of-life (QOL) preservation. Radiosurgical treatments, including GammaKnife radiosurgery (GKRS), offer excellent local control of intracranial disease. However, QOL outcomes following GKRS have been poorly characterized, particularly for patients with multiple treated metastases.
METHODS: A prospectively collected database of patient-reported measures was queried for all patients undergoing GKRS for brain metastasis. The EuroQol (EQ)-5D and Patient Health Questionnaire (PHQ)-9 measures were used. Time to EQ-5D deterioration was the primary outcome. Proportional hazards modeling was used to control for confounding differences among patients with single and multiple metastases.
RESULTS: A total of 122 treatments (67 patients) for 421 lesions were eligible for inclusion. Intracranial failure occurred following 35% of treatments. Among 421 lesions, 8% enlarged radiologically following GKRS. Salvage whole-brain radiation therapy (RT) was conducted following 16% of cases, while GKRS was conducted following 50% of cases. Median follow-up was 12 months.
All subscores of the EQ-5D instrument worsened significantly (P < .01) at last follow-up. Clinically significant EQ-5D deterioration occurred following 28% of treatments, while improvement occurred following 24%. Overall PHQ-9 score did not differ significantly at last follow-up. However, patients reported greater difficulty in daily activities secondary to depressive symptoms (P = .02). PHQ-9 failure was observed following 35% of treatments. At last follow-up, Karnofsky performance status (KPS) worsened significantly (P < .01).
After controlling for confounding characteristics, patients with more than three brain metastases experienced more rapid QOL deterioration (hazard ratio, 2.13 [95% CI, 1.28–3.60]; P < .01) than those with a single metastasis.
CONCLUSIONS: QOL preservation in patients with terminal illnesses, such as brain metastasis, must remain paramount as healthcare technology continues to progress. In the present investigation, 72% of patients maintained their QOL following GKRS, with 24% of patients experiencing clinically significant improvement.
Proceedings of the 98th Annual Meeting of the American Radium Society - americanradiumsociety.org