Skip to main content

Advertisement

SpringerLink
Log in

Health related quality of life trajectories after stereotactic radiosurgery for brain metastases: a systematic review

  • Review
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Health related quality of life (HRQoL) is often used as an outcome measure of cancer treatment. Stereotactic radiosurgery (SRS) is a mainstay treatment of brain metastases (BMs) with constantly improving treatment envelope. The goal of this systematic review was to evaluated HRQoL trajectories after SRS, identify important predictors of HRQoL after SRS, and to evaluate clinical importance of post-SRS HRQoL trajectories of BM patients treated with SRS.

Methods

A systematic literature review according to the PRISMA guidelines analyzing HRQoL trajectories after SRS for BM published in the Pubmed/MEDLINE database before January, 2022.

Results

We identified 18 studies that evaluated HRQoL before and at least once after SRS for BMs. The majority of studies were single-institution retrospective series and included patients with different cancer types. Different instruments were used to assess HRQoL. In the majority of studies (n = 10) at group level, there was no significant change in global HRQoL after SRS. Stability, improvement, and deterioration of HRQoL global and subscale scores at individual patient level were common. Post-SRS HRQoL deterioration was predicted by worse functional status, greater number of BMs, delayed SRS, symptomatic BMs, and presence of seizures and cognitive impairment. Shorter post-SRS survival and adverse radiation effects (AREs) were associated with worse HRQoL.

Conclusions

SRS for BMs is often associated with sustained preservation of HRQoL. Individual variation of HRQoL domains after SRS is common. Shorter survival and AREs are associated with worse HRQoL. Worse functional status and greater disease burden predict unfavorable HRQoL trajectories after SRS for BMs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nayak L, Lee EQ, Wen PY (2012) Epidemiology of brain metastases. Curr Oncol Rep 14:48–54. https://doi.org/10.1007/s11912-011-0203-y

    Article  PubMed  Google Scholar 

  2. Butowski NA (2015) Epidemiology and Diagnosis of Brain Tumors. Continuum Lifelong Learning Neurol. https://doi.org/10.1212/01.CON.0000464171.50638.fa

    Article  Google Scholar 

  3. Davis FG, Dolecek TA, McCarthy BJ, Villano JL (2012) Toward determining the lifetime occurrence of metastatic brain tumors estimated from 2007 United States cancer incidence data. Neuro Oncol 14:1171–1177. https://doi.org/10.1093/neuonc/nos152

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wen PY, Loeffler JS (1999) Management of brain metastases. Oncology 13:941–954

    CAS  PubMed  Google Scholar 

  5. Lin X, DeAngelis LM (2015) Treatment of brain metastases. J Clin Oncol 33:3475–3484. https://doi.org/10.1200/JCO.2015.60.9503

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Soffietti R, Cornu P, Delattre JY et al (2006) EFNS guidelines on diagnosis and treatment of brain metastases: report of an EFNS task force. Eur J Neurol 13:674–681. https://doi.org/10.1111/j.1468-1331.2006.01506.x

    Article  CAS  PubMed  Google Scholar 

  7. Churilla TM, Ballman KV, Brown PD et al (2017) Stereotactic radiosurgery with or without whole-brain radiation therapy for limited brain metastases: a secondary analysis of the north central cancer treatment group n0574 (alliance) randomized controlled trial. Int J Radiat Oncol Biol Phys 99:1173–1178. https://doi.org/10.1016/j.ijrobp.2017.07.045

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kayama T, Sato S, Sakurada K et al (2018) Effects of surgery with salvage stereotactic radiosurgery versus surgery with whole-brain radiation therapy in patients with one to four brain metastases (JCOG0504) A Phase III, noninferiority, randomized controlled trial. J Clin Oncol. https://doi.org/10.1200/JCO.2018.78.6186

    Article  PubMed  Google Scholar 

  9. Chang EL, Wefel JS, Hess KR et al (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10:1037–1044. https://doi.org/10.1016/S1470-2045(09)70263-3

    Article  PubMed  Google Scholar 

  10. Li J, Ludmir EB, Wang Y et al (2020) Stereotactic radiosurgery versus whole-brain radiation therapy for patients with 4–15 brain metastases: a phase III randomized controlled trial. Int J Radiat Oncol Biol Phys 108:S21–S22. https://doi.org/10.1016/j.ijrobp.2020.07.2108

    Article  Google Scholar 

  11. Tsao M, Xu W, Sahgal A (2012) A meta-analysis evaluating stereotactic radiosurgery, whole-brain radiotherapy, or both for patients presenting with a limited number of brain metastases. Cancer 118:2486–2493. https://doi.org/10.1002/cncr.26515

    Article  PubMed  Google Scholar 

  12. Kann BH, Park HS, Johnson SB et al (2017) Radiosurgery for Brain Metastases: changing practice patterns and disparities in the United States. J Natl Compr Canc Netw 15:1494–1502. https://doi.org/10.6004/jnccn.2017.7003

    Article  PubMed  Google Scholar 

  13. Bottomley A, Pe M, Sloan J et al (2016) Analysing data from patient-reported outcome and quality of life endpoints for cancer clinical trials: a start in setting international standards. Lancet Oncol 17:e510–e514. https://doi.org/10.1016/S1470-2045(16)30510-1

    Article  PubMed  Google Scholar 

  14. Ediebah DE, Quinten C, Coens C et al (2018) Quality of life as a prognostic indicator of survival: a pooled analysis of individual patient data from Canadian cancer trials group clinical trials. Cancer 124:3409–3416. https://doi.org/10.1002/cncr.31556

    Article  PubMed  Google Scholar 

  15. Quinten C, Coens C, Mauer M et al (2009) Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials. Lancet Oncol 10:865–871. https://doi.org/10.1016/S1470-2045(09)70200-1

    Article  PubMed  Google Scholar 

  16. Mauer M, Stupp R, Taphoorn MJB et al (2007) The prognostic value of health-related quality-of-life data in predicting survival in glioblastoma cancer patients: results from an international randomised phase III EORTC brain tumour and radiation oncology groups, and NCIC clinical trials group study. Br J Cancer 97:302–307. https://doi.org/10.1038/sj.bjc.6603876

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Verhaak E, Gehring K, Hanssens PEJ et al (2019) Health-related quality of life in adult patients with brain metastases after stereotactic radiosurgery: a systematic, narrative review. Support Care Cancer. https://doi.org/10.1007/s00520-019-05136-x

    Article  PubMed  PubMed Central  Google Scholar 

  18. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  19. Berger A, Strauss I, Ben Moshe S et al (2018) Neurocognitive evaluation of brain metastases patients treated with post-resection stereotactic radiosurgery: a prospective single arm clinical trial. J Neurooncol 140:307–315. https://doi.org/10.1007/s11060-018-2954-x

    Article  PubMed  Google Scholar 

  20. Sheehan JP, Grills I, Chiang VL et al (2018) Quality of life outcomes for brain metastasis patients treated with stereotactic radiosurgery: pre-procedural predictive factors from a prospective national registry. J Neurosurg. https://doi.org/10.3171/2018.8.JNS181599

    Article  PubMed  Google Scholar 

  21. Kim GJ, Buckley ED, Herndon JE et al (2021) Outcomes in patients with 4 to 10 brain metastases treated with dose-adapted single-isocenter multitarget stereotactic radiosurgery: a prospective study. Adv Radiat Oncol 6:100760. https://doi.org/10.1016/j.adro.2021.100760

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hartgerink D, Bruynzeel A, Eekers D et al (2021) A Dutch phase III randomized multicenter trial: whole brain radiotherapy versus stereotactic radiotherapy for 4–10 brain metastases. Neurooncol Adv. https://doi.org/10.1093/noajnl/vdab021

    Article  PubMed  PubMed Central  Google Scholar 

  23. Verhaak E, Schimmel WCM, Gehring K et al (2021) Health-related quality of life after gamma knife radiosurgery in patients with 1–10 brain metastases. J Cancer Res Clin Oncol 147:1157–1167. https://doi.org/10.1007/s00432-020-03400-w

    Article  CAS  PubMed  Google Scholar 

  24. Bragstad S, Flatebø M, Natvig GK et al (2018) Predictors of quality of life and survival following gamma knife surgery for lung cancer brain metastases: a prospective study. J Neurosurg 129:71–83. https://doi.org/10.3171/2017.2.JNS161659

    Article  PubMed  Google Scholar 

  25. Rahimy E, Dudley SA, von Eyben R et al (2021) Phase I/II dose-escalation trial of 3-fraction stereotactic radiosurgery for resection cavities from large brain metastases: health-related quality of life outcomes. Am J Clin Oncol 44:588–595. https://doi.org/10.1097/COC.0000000000000868

    Article  CAS  PubMed  Google Scholar 

  26. Brown PD, Ballman KV, Cerhan JH et al (2017) Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 18:1049–1060. https://doi.org/10.1016/S1470-2045(17)30441-2

    Article  PubMed  PubMed Central  Google Scholar 

  27. Skeie BS, Eide GE, Flatebø M et al (2017) Quality of life is maintained using Gamma Knife radiosurgery: a prospective study of a brain metastases patient cohort. J Neurosurg 126:708–725. https://doi.org/10.3171/2015.10.JNS15801

    Article  PubMed  Google Scholar 

  28. Brown PD, Jaeckle K, Ballman KV et al (2016) Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA 316:401–409. https://doi.org/10.1001/jama.2016.9839

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kirkpatrick JP, Wang Z, Sampson JH et al (2015) Defining the optimal planning target volume in image-guided stereotactic radiosurgery of brain metastases: results of a randomized trial. Int J Radiat Oncol Biol Phys 91:100–108. https://doi.org/10.1016/j.ijrobp.2014.09.004

    Article  PubMed  Google Scholar 

  30. Miller JA, Kotecha R, Barnett GH et al (2017) Quality of life following stereotactic radiosurgery for single and multiple brain metastases. Neurosurgery 81:147–155. https://doi.org/10.1093/neuros/nyw166

    Article  PubMed  Google Scholar 

  31. Bunevicius A, Lavezzo K, Shabo L et al (2020) Quality-of-life trajectories after stereotactic radiosurgery for brain metastases. J Neurosurg 134:1791–1799. https://doi.org/10.3171/2020.4.JNS20788

    Article  PubMed  Google Scholar 

  32. Habets EJJ, Dirven L, Wiggenraad RG et al (2016) Neurocognitive functioning and health-related quality of life in patients treated with stereotactic radiotherapy for brain metastases: a prospective study. Neuro Oncol 18:435–444. https://doi.org/10.1093/neuonc/nov186

    Article  CAS  PubMed  Google Scholar 

  33. Steinmann D, Vordermark D, Gerstenberg W et al (2020) Quality of life in patients with limited (1–3) brain metastases undergoing stereotactic or whole brain radiotherapy : a prospective study of the DEGRO QoL working group. Strahlenther Onkol 196:48–57. https://doi.org/10.1007/s00066-019-01506-w

    Article  PubMed  Google Scholar 

  34. van der Meer PB, Habets EJJ, Wiggenraad RG et al (2018) Individual changes in neurocognitive functioning and health-related quality of life in patients with brain oligometastases treated with stereotactic radiotherapy. J Neuro oncol 139:359–368. https://doi.org/10.1007/s11060-018-2868-7

    Article  Google Scholar 

  35. Kotecha R, Damico N, Miller JA et al (2017) Three or More Courses of Stereotactic Radiosurgery for Patients with Multiply Recurrent Brain Metastases. Neurosurgery 80:871–879. https://doi.org/10.1093/neuros/nyw147

    Article  PubMed  Google Scholar 

  36. Randolph DM, McTyre E, Klepin H et al (2017) Impact of radiosurgical management of geriatric patients with brain metastases: clinical and quality of life outcomes. J Radiosurg SBRT 5:35–42

    PubMed  PubMed Central  Google Scholar 

  37. Soffietti R, Kocher M, Abacioglu UM et al (2013) A European organisation for research and treatment of cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. J Clin Oncol 31:65–72. https://doi.org/10.1200/JCO.2011.41.0639

    Article  PubMed  Google Scholar 

  38. Yamamoto M, Serizawa T, Higuchi Y et al (2017) A multi-institutional prospective observational study of stereotactic radiosurgery for patients with multiple brain metastases (jlgk0901 study update): irradiation-related complications and long-term maintenance of mini-mental state examination scores. Int J Radiat Oncol Biol Phys 99:31–40. https://doi.org/10.1016/j.ijrobp.2017.04.037

    Article  PubMed  Google Scholar 

  39. Vulpe H, Save AV, Xu Y et al (2020) Frameless stereotactic radiosurgery on the gamma knife icon: early experience from 100 patients. Neurosurgery 86:509–516. https://doi.org/10.1093/neuros/nyz227

    Article  PubMed  Google Scholar 

  40. Bunevicius A, Sheehan D, Lee Vance M et al (2020) Outcomes of cushing’s disease following gamma knife radiosurgery: effect of a center’s growing experience and era of treatment. J Neurosurg. https://doi.org/10.3171/2019.12.JNS192743

    Article  PubMed  Google Scholar 

  41. Bunevicius A, Sheehan JP (2021) Radiosurgery for Glioblastoma. Neurosurg Clin N Am 32:117–128. https://doi.org/10.1016/j.nec.2020.08.007

    Article  PubMed  Google Scholar 

  42. Sperduto PW, Mesko S, Li J et al (2020) Survival in patients with brain metastases: summary report on the updated diagnosis-specific graded prognostic assessment and definition of the eligibility quotient. J Clin Oncol 38:3773–3784. https://doi.org/10.1200/JCO.20.01255

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Hall WA, Djalilian HR, Nussbaum ES, Cho KH (2000) Long-term survival with metastatic cancer to the brain. Med Oncol 17:279–286. https://doi.org/10.1007/BF02782192

    Article  CAS  PubMed  Google Scholar 

  44. Achrol AS, Rennert RC, Anders C et al (2019) Brain metastases. Nat Rev Dis Primers 5:5. https://doi.org/10.1038/s41572-018-0055-y

    Article  PubMed  Google Scholar 

  45. Sheehan JP, Kavanagh BD, Asher A, Harbaugh RE (2016) Inception of a national multidisciplinary registry for stereotactic radiosurgery. J Neurosurg 124:155–162. https://doi.org/10.3171/2015.1.JNS142466

    Article  PubMed  Google Scholar 

  46. Buneviciene I, Mekary RA, Smith TR et al (2021) Can mHealth interventions improve quality of life of cancer patients? a systematic review and meta-analysis. Crit Rev Oncol Hematol 157:103123

    Article  Google Scholar 

  47. Mooney K, Iacob E, Wilson CM et al (2021) Randomized trial of remote cancer symptom monitoring during COVID-19: impact on symptoms, QoL, and unplanned health care utilization. J Clin Oncol 39:12000. https://doi.org/10.1200/JCO.2021.39.15_suppl.12000

    Article  Google Scholar 

  48. Caissie A, Nguyen J, Chen E et al (2012) Quality of life in patients with brain metastases using the EORTC QLQ-BN20+2 and QLQ-C15-PAL. Int J Radiat Oncol Biol Phys 83:1238–1245. https://doi.org/10.1016/j.ijrobp.2011.09.025

    Article  PubMed  Google Scholar 

  49. Thavarajah N, Bedard G, Zhang L et al (2014) Psychometric validation of the functional assessment of cancer therapy–brain (FACT-Br) for assessing quality of life in patients with brain metastases. Support Care Cancer 22:1017–1028. https://doi.org/10.1007/s00520-013-2060-8

    Article  PubMed  Google Scholar 

  50. Chen J, Gao Y, Baek J et al (2018) Routine collection of EQ-5D-5L derived utility scores in a brain metastases clinic: correlation with health-related quality of life (FACT-Br). J Clin Oncol 36:200–200. https://doi.org/10.1200/JCO.2018.36.30_suppl.200

    Article  Google Scholar 

Download references

Funding

Dr. Donovan was supported in part by The William Rhodes and Louise Tilzer-Rhodes Center for Glioblastoma at NewYork-Presbyterian Hospital. Other authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 710 W 168th St, New York, NY, 10033, USA

    Adomas Bunevicius

  2. Division of Neuro-Oncology, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, USA

    Laura Donovan

  3. Herbert Irving Comprehensive Cancer Center, NewYork-Presbyterian Hospital, New York, NY, USA

    Laura Donovan

  4. Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, 22908, USA

    Jason Sheehan

Authors
  1. Adomas Bunevicius
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Donovan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jason Sheehan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AB, LD and JS. The first draft of the manuscript was written by AB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Adomas Bunevicius.

Ethics declarations

Conflict of Interest

The authors have no relevant financial or non-financial interests to disclose.

Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publish

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bunevicius, A., Donovan, L. & Sheehan, J. Health related quality of life trajectories after stereotactic radiosurgery for brain metastases: a systematic review. J Neurooncol 159, 319–331 (2022). https://doi.org/10.1007/s11060-022-04067-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-022-04067-8

Keywords

Search

Navigation