Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2012

Open Access 01-12-2012 | Research article

Prospective evaluation of quality of life effects in patients undergoing palliative radiotherapy for brain metastases

Authors: Diana Steinmann, Yvonne Paelecke-Habermann, Hans Geinitz, Raimund Aschoff, Anja Bayerl, Tobias Bölling, Elisabeth Bosch, Frank Bruns, Ute Eichenseder-Seiss, Johanna Gerstein, Nadine Gharbi, Juliane Hagg, Matthias Hipp, Irmgard Kleff, Axel Müller, Christof Schäfer, Ursula Schleicher, Susanne Sehlen, Marilena Theodorou, Hans-Joachim Wypior, Franz Zehentmayr, Birgitt van Oorschot, Dirk Vordermark

Published in: BMC Cancer | Issue 1/2012

Login to get access

Abstract

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.
Appendix
Available only for authorised users
Literature
1.
Steinmann D, Schäfer C, van Oorschot B, Wypior HJ, Bruns F, Bölling T, Sehlen S, Hagg J, Bayerl A, Geinitz H, Hipp M, Vordermark D: Effects of radiotherapy for brain metastases on quality of life (QoL). Prospective pilot study of the DEGRO QoL working party. Strahlenther Onkol. 2009, 185: 190-197. 10.1007/s00066-009-1904-0.CrossRefPubMed
2.
Wong J, Hird A, Kirou-Mauro A, Napolskikh J, Chow E: Quality of life in brain metastases radiation trials: a literature review. Curr Oncol. 2008, 15 (5): 25-45.CrossRefPubMedPubMedCentral
3.
Wong J, Hird A, Zhang L, Tsao M, Sinclair E, Barnes E, Danjoux C, Chow E: Symptoms and quality of life in cancer patients with brain metastases following palliative radiotherapy. Int J Radiat Oncol Biol Phys. 2009, 75 (4): 1125-1131. 10.1016/j.ijrobp.2008.12.013.CrossRefPubMed
4.
Caissie A, Nguyen J, Chen E, Zhang L, Sahgal A, Clemons M, Kerba M, Arnalot PF, Danjoux C, Tsao M, Barnes E, Holden L, Danielson B, Chow E: Quality of Life in Patients with Brain Metastases Using the EORTC QLQ-BN20+2 and QLQ-C15-PAL. Int J Radiat Oncol Biol Phy. 2011, Dec 13. [Epub ahead of print]
5.
Chow E, Davis L, Holden L, Tsao M, Danjoux C: Prospective assessment of patient-rated symptoms following whole brain radiotherapy for brain metastases. J Pain Symptom Manage. 2005, 30 (1): 18-23. 10.1016/j.jpainsymman.2005.02.009.CrossRefPubMed
6.
Barnes EA, Chow E, Tsao MN, Bradley NM, Doyle M, Li K, Lam K, Danjoux C: Physician expectations of treatment outcomes for patients with brain metastases referred for whole brain radiotherapy. Int J Radiat Oncol Biol Phys. 2010, 76 (1): 187-192. 10.1016/j.ijrobp.2009.01.035.CrossRefPubMed
7.
Temel JS, Greer JA, Admane S, Gallagher ER, Jackson VA, Lynch TJ, Lennes IT, Dahlin CM, Pirl WF: Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol. 2011, 29 (17): 2319-2326. 10.1200/JCO.2010.32.4459.CrossRefPubMed
8.
Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R: Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997, 37 (4): 745-751. 10.1016/S0360-3016(96)00619-0.CrossRefPubMed
9.
Gaspar LE, Scott C, Murray K, Curran W: Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys. 2000, 47 (4): 1001-1006. 10.1016/S0360-3016(00)00547-2.CrossRefPubMed
10.
Meyer A, Steinmann D, Malaimare L, Karstens JH, Bremer M: Prediction of prognosis regarding fractionation schedule and survival in patients with whole-brain radiotherapy for metastatic disease. Anticancer Res. 2008, 28 (6B): 3965-3969.PubMed
11.
Rades D, Dziggel L, Haatanen T, Veninga T, Lohynska R, Dunst J, Schild SE: Scoring systems to estimate intracerebral control and survival rates of patients irradiated for brain metastases. Int J Radiat Oncol Biol Phys. 2011, 80 (4): 1122-1127. 10.1016/j.ijrobp.2010.03.031.CrossRefPubMed
12.
Sperduto CM, Watanabe Y, Mullan J, Hood T, Dyste G, Watts C, Bender GP, Sperduto P: A validation study of a new prognostic index for patients with brain metastases: the Graded Prognostic Assessment. J Neurosurg. 2008, 109 (Suppl): 87-89.PubMed
13.
Mahoney FI: BARTHEL DW: Functional Evaluation: the Barthel Index. Md State Med J. 1965, 14: 61-65.PubMed
14.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC: The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993, 85 (5): 365-376. 10.1093/jnci/85.5.365.CrossRefPubMed
15.
Groenvold M, Petersen MA, Aaronson NK, Arraras JI, Blazeby JM, Bottomley A, Fayers PM, de Graeff A, Hammerlid E, Kaasa S, Sprangers MA, Bjorner JB: EORTC Quality of Life Group: The development of the EORTC QLQ-C15-PAL: a shortened questionnaire for cancer patients in palliative care. Eur J Cancer. 2006, 42 (1): 55-64. 10.1016/j.ejca.2005.06.022.CrossRefPubMed
16.
Fayers PM: Interpreting quality of life data: population-based reference data for the EORTC QLQ-C30. Eur J Cancer. 2001, 37 (11): 1331-1334. 10.1016/S0959-8049(01)00127-7.CrossRefPubMed
17.
Slotman BJ, Mauer ME, Bottomley A, Faivre-Finn C, Kramer GW, Rankin EM, Snee M, Hatton M, Postmus PE, Collette L, Senan S: Prophylactic cranial irradiation in extensive disease small-cell lung cancer: short-term health-related quality of life and patient reported symptoms: results of an international Phase III randomized controlled trial by the EORTC Radiation Oncology and Lung Cancer Groups. J Clin Oncol. 2009, 27 (1): 78-84.CrossRefPubMed
18.
Osoba D, Rodrigues G, Myles J, Zee B, Pater J: Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998, 16 (1): 139-144.PubMed
19.
Addeo R, Caraglia M, Faiola V, Capasso E, Vincenzi B, Montella L, Guarrasi R, Caserta L, Del Prete S: Concomitant treatment of brain metastasis with whole brain radiotherapy [WBRT] and temozolomide [TMZ] is active and improves quality of life. BMC Cancer. 2007, 7: 18-10.1186/1471-2407-7-18.CrossRefPubMedPubMedCentral
20.
Bezjak A, Adam J, Barton R, Panzarella T, Laperriere N, Wong CS, Mason W, Buckley C, Levin W, McLean M, Wu JS, Sia M, Kirkbride P: Symptom response after palliative radiotherapy for patients with brain metastases. Eur J Cancer. 2002, 38 (4): 487-496. 10.1016/S0959-8049(01)00150-2.CrossRefPubMed
21.
Sehlen S, Lenk M, Hollenhorst H, Schymura B, Aydemir U, Herschbach P, Duhmke E: Quality of life (QoL) as predictive mediator variable for survival in patients with intracerebral neoplasma during radiotherapy. Onkologie. 2003, 26 (1): 38-43. 10.1159/000069862.PubMed
22.
Taphoorn MJ, Claassens L, Aaronson NK, Coens C, Mauer M, Osoba D, Stupp R, Mirimanoff RO, van den Bent MJ, Bottomley A: EORTC Quality of Life Group, and Brain Cancer, NCIC and Radiotherapy Groups: An international validation study of the EORTC brain cancer module (EORTC QLQ-BN20) for assessing health-related quality of life and symptoms in brain cancer patients. Eur J Cancer. 2010, 46 (6): 1033-1040. 10.1016/j.ejca.2010.01.012.CrossRefPubMed
23.
Roos DE, Wirth A, Burmeister BH, Spry NA, Drummond KJ, Beresford JA, McClure BE: Whole brain irradiation following surgery or radiosurgery for solitary brain metastases: mature results of a prematurely closed randomized Trans-Tasman Radiation Oncology Group trial (TROG 98.05). Radiother Oncol. 2006, 80 (3): 318-322. 10.1016/j.radonc.2006.08.004.CrossRefPubMed
24.
Gerrard GE, Prestwich RJ, Edwards A, Russon LJ, Richards F, Johnston CF, Kwok-Williams MC: Investigating the palliative efficacy of whole-brain radiotherapy for patients with multiple-brain metastases and poor prognostic features. Clin Oncol (R Coll Radiol). 2003, 15 (7): 422-428. 10.1016/S0936-6555(03)00148-1.CrossRef
25.
Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W: A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys. 2008, 70 (2): 510-514. 10.1016/j.ijrobp.2007.06.074.CrossRefPubMed
26.
Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D, Bhatt A, Jensen AW, Brown PD, Shih H, Kirkpatrick J, Schwer A, Gaspar LE, Fiveash JB, Chiang V, Knisely J, Sperduto CM, Mehta M: Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010, 77 (3): 655-661. 10.1016/j.ijrobp.2009.08.025.CrossRefPubMed
27.
Koyfman SA, Tendulkar RD, Chao ST, Vogelbaum MA, Barnett GH, Angelov L, Weil RJ, Neyman G, Reddy CA, Suh JH: Stereotactic radiosurgery for single brainstem metastases: the cleveland clinic experience. Int J Radiat Oncol Biol Phys. 2010, 78 (2): 409-414. 10.1016/j.ijrobp.2009.07.1750.CrossRefPubMed
28.
Feyer P, Sautter-Bihl ML, Budach W, Dunst J, Haase W, Harms W, Sedlmayer F, Souchon R, Wenz F, Sauer R: Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO): DEGRO Practical Guidelines for palliative radiotherapy of breast cancer patients: brain metastases and leptomeningeal carcinomatosis. Strahlenther Onkol. 2010, 186 (2): 63-69. 10.1007/s00066-010-2100-y.CrossRefPubMed
29.
Tang V, Rathbone M, Park Dorsay J, Jiang S, Harvey D: Rehabilitation in primary and metastatic brain tumours: impact of functional outcomes on survival. J Neurol. 2008, 255 (6): 820-827. 10.1007/s00415-008-0695-z.CrossRefPubMed
30.
Lagerwaard FJ, Levendag PC, Nowak PJ, Eijkenboom WM, Hanssens PE, Schmitz PI: Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys. 1999, 43 (4): 795-803. 10.1016/S0360-3016(98)00442-8.CrossRefPubMed
31.
Eichler AF, Kuter I, Ryan P, Schapira L, Younger J, Henson JW: Survival in patients with brain metastases from breast cancer: the importance of HER-2 status. Cancer. 2008, 112 (11): 2359-2367. 10.1002/cncr.23468.CrossRefPubMed
32.
Li J, Bentzen SM, Renschler M, Mehta MP: Regression after whole-brain radiation therapy for brain metastases correlates with survival and improved neurocognitive function. J Clin Oncol. 2007, 25 (10): 1260-1266. 10.1200/JCO.2006.09.2536.CrossRefPubMed
33.
Movsas B, Moughan J, Sarna L, Langer C, Werner-Wasik M, Nicolaou N, Komaki R, Machtay M, Wasserman T, Bruner DW: Quality of life supersedes the classic prognosticators for long-term survival in locally advanced non-small-cell lung cancer: an analysis of RTOG 9801. J Clin Oncol. 2009, 27 (34): 5816-5822. 10.1200/JCO.2009.23.7420.CrossRefPubMedPubMedCentral
34.
Montazeri A, Milroy R, Hole D, McEwen J, Gillis CR: Quality of life in lung cancer patients: as an important prognostic factor. Lung Cancer. 2001, 31 (2–3): 233-240.CrossRefPubMed
35.
Montazeri A: Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008. Health Qual Life Outcomes. 2009, 7: 102-10.1186/1477-7525-7-102.CrossRefPubMedPubMedCentral
36.
Gotay CC, Kawamoto CT, Bottomley A, Efficace F: The prognostic significance of patient-reported outcomes in cancer clinical trials. J Clin Oncol. 2008, 26 (8): 1355-1363. 10.1200/JCO.2007.13.3439.CrossRefPubMed
37.
Brown PD, Ballman KV, Rummans TA, Maurer MJ, Sloan JA, Boeve BF, Gupta L, Tang-Wai DF, Arusell RM, Clark MM, Buckner JC: Prospective study of quality of life in adults with newly diagnosed high-grade gliomas. J Neurooncol. 2006, 76 (3): 283-291. 10.1007/s11060-005-7020-9.CrossRefPubMed
38.
Sundaresan P, Yeghiaian-Alvandi R, Gebski V: Prognostic index to identify patients who may not benefit from whole brain radiotherapy for multiple brain metastases from lung cancer. J Med Imaging Radiat Oncol. 2010, 54 (1): 69-75. 10.1111/j.1754-9485.2010.02140.x.CrossRefPubMed
Metadata
Title
Prospective evaluation of quality of life effects in patients undergoing palliative radiotherapy for brain metastases
Authors
Diana Steinmann
Yvonne Paelecke-Habermann
Hans Geinitz
Raimund Aschoff
Anja Bayerl
Tobias Bölling
Elisabeth Bosch
Frank Bruns
Ute Eichenseder-Seiss
Johanna Gerstein
Nadine Gharbi
Juliane Hagg
Matthias Hipp
Irmgard Kleff
Axel Müller
Christof Schäfer
Ursula Schleicher
Susanne Sehlen
Marilena Theodorou
Hans-Joachim Wypior
Franz Zehentmayr
Birgitt van Oorschot
Dirk Vordermark
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2012
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-12-283

Other articles of this Issue 1/2012

BMC Cancer 1/2012 Go to the issue

Research article

Loss of aquaporin 3 protein expression constitutes an independent prognostic factor for progression-free survival: an immunohistochemical study on stage pT1 urothelial bladder cancer

Research article

JS-K, a glutathione/glutathione S-transferase-activated nitric oxide releasing prodrug inhibits androgen receptor and WNT-signaling in prostate cancer cells

Research article

Increased serum sTRAIL levels were correlated with survival in bevacizumab-treated metastatic colon cancer

Research article

Downregulation of organic cation transporters OCT1 (SLC22A1) and OCT3 (SLC22A3) in human hepatocellular carcinoma and their prognostic significance

Research article

Nuclear translocation of the cytoplasmic domain of HB-EGF induces gastric cancer invasion

Study protocol

How should we discuss genetic testing with women newly diagnosed with breast cancer? Design and implementation of a randomized controlled trial of two models of delivering education about treatment-focused genetic testing to younger women newly diagnosed with breast cancer
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits