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Strahlentherapie und Onkologie

, Volume 185, Issue 3, pp 190–197 | Cite as

Effects of Radiotherapy for Brain Metastases on Quality of Life (QoL)

Prospective Pilot Study of the DEGRO QoL Working Party
  • Diana Steinmann
  • Christof Schäfer
  • Birgitt van Oorschot
  • Hans-Joachim Wypior
  • Frank Bruns
  • Tobias Bölling
  • Susanne Sehlen
  • Juliane Hagg
  • Anja Bayerl
  • Hans Geinitz
  • Matthias Hipp
  • Dirk Vordermark
Original Article

Background:

Prospective data on quality-of-life (QoL) effects of radiotherapy for brain metastases are currently lacking, but would be of great interest to guide therapeutic decisions.

Patients and Methods:

From 01/2007 to 08/2007, 46 patients with previously untreated brain metastases were recruited at eight centers. QoL was measured at start of treatment (T0) and at 3 months (T3mo). In the pilot study, two combinations of QoL instruments could be used at the discretion of the centers (A: EORTC QLQ-C30 and B: EORTC QLQ-C15-PAL both with brain module BN20, assessment by proxies with A: Palliative Care Outcome Scale, B: self-constructed brain-specific instrument).

Results:

All patients received whole-brain radiotherapy, four with an additional boost irradiation. At T3mo, 26/46 patients (56.5%) had died. 17/20 survivors (85%) completed the questionnaires. In 3-month survivors, QoL deteriorated in most domains, significant in drowsiness, hair loss and weakness of legs. The scores for headaches and seizures were slightly better after 3 months. Assessment by proxies also suggested worsening of QoL. Initial QoL at T0 was better in those alive than in those deceased at T3mo, significant for physical function and for the symptom scales of fatigue and pain, motor dysfunction, communication deficit and weakness of legs.

Conclusion:

Practicability and compliance appeared better with the (shorter) version B. This version is now used in the ongoing main phase of the study with additional centers. First results indicate a moderate worsening of QoL during the first 3 months after start of palliative radiotherapy for brain metastases. QoL at initiation of radiotherapy may be prognostic for survival.

Key Words:

Quality of life Brain metastases Radiotherapy 

Lebensqualitäts-(LQ-)Effekte der Strahlentherapie von Hirnmetastasen. Prospektive Pilotstudie des DEGRO-LQ-Arbeitskreises

Hintergrund:

Prospektive Daten über die Auswirkung einer palliativen Strahlentherapie auf die Lebensqualität (LQ) von Patienten mit Hirnmetastasen existieren nur wenige, jedoch sind sie von großem Interesse für Therapieentscheidungen.

Patienten und Methodik:

Von 01/2007 bis 08/2007 wurden an acht Zentren 46 Patienten mit bisher unbehandelten Hirnmetastasen rekrutiert (Tabelle 1). Die LQ vor und 3 Monate nach palliativer Strahlentherapie wurde erhoben. In der Pilotphase konnten die Zentren zwischen zwei Kombinationen von Instrumenten wählen (A: EORTC QLQ-C30 und B: QLQ C15-PAL jeweils mit Hirnmodul BN20, Fremdeinschätzung durch Angehörige mittels A: Palliative Care Outcome Scale, B: eigenen Hirnmoduls).

Ergebnisse:

Alle Patienten erhielten eine Ganzhirnbestrahlung, vier Patienten zusätzlich eine Boostbestrahlung. 3 Monate nach Therapiebeginn waren 26/46 Patienten (56,5%) verstorben. Die Rücklaufquote der Fragebögen der Überlebenden betrug 17/20 (85%). Für dieses Kollektiv der 3-Monats-Überlebenden zeigte die Selbsteinschätzung eine Verschlechterung in den meisten Bereichen, signifikant für Schläfrigkeit, Alopezie und Beinschwäche. Die Scores für Kopfschmerzen und Krampfleiden waren nach 3 Monaten etwas besser (Abbildung 1). Die Fremdeinschätzungen zeigten ebenfalls eine zunehmende Beeinträchtigung der Patienten nach 3 Monaten (Abbildung 2). Die initiale LQ war bei den 3-Monats-Überlebenden (Abbildung 3a) im Vergleich zu den Verstorbenen besser, signifikant für die körperliche Funktion und für die Symptomskalen Fatigue, Schmerz (Abbildung 3b), motorische Dysfunktion, Kommunikationsdefizit und Beinschwäche (Abbildung 3c).

Schlussfolgerung:

Die kürzere Fragebogenvariante B schien bezüglich der Praktikabilität und Compliance besser zu sein. Demzufolge wird diese Variante in der aktuell laufenden Hauptphase mit zusätzlichen Zentren verwendet (Abbildung 4). Erste Ergebnisse deuten auf eine mäßige LQ-Verschlechterung bei 3-Monats-Überlebenden hin. Möglicherweise könnte die initiale objektivierte LQ als prädiktiver Faktor herangezogen werden.

Schlüsselwörter:

Lebensqualität Hirnmetastasen Strahlentherapie 

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Copyright information

© Urban & Vogel, Muenchen 2009

Authors and Affiliations

  • Diana Steinmann
    • 1
    • 11
  • Christof Schäfer
    • 2
  • Birgitt van Oorschot
    • 3
  • Hans-Joachim Wypior
    • 4
  • Frank Bruns
    • 1
  • Tobias Bölling
    • 5
  • Susanne Sehlen
    • 6
  • Juliane Hagg
    • 7
  • Anja Bayerl
    • 8
  • Hans Geinitz
    • 9
  • Matthias Hipp
    • 2
  • Dirk Vordermark
    • 10
  1. 1.Radiation OncologyMedical SchoolHannoverGermany
  2. 2.Radiation OncologyUniversity of RegensburgRegensburgGermany
  3. 3.Radiation OncologyUniversity of WürzburgWürzburgGermany
  4. 4.Radiation OncologyHospital LandshutLandshutGermany
  5. 5.Radiation OncologyUniversity of MünsterMünsterGermany
  6. 6.Radiation OncologyLudwig Maximilians UniversityMunichGermany
  7. 7.Radiation OncologyUniversity of UlmUlmGermany
  8. 8.Radiation OncologyHospital KremsKremsAustria
  9. 9.Radiation OncologyTechnical UniversityMunichGermany
  10. 10.Radiation OncologyMartin Luther UniversityHalle-WittenbergGermany
  11. 11.Klinik für Strahlentherapie und spezielle Onkologie, OE 8240 Medizinische Hochschule HannoverHannoverGermany

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