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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
  • Diana SteinmannEmail author
  • Dirk Vordermark
  • Wiebke Gerstenberg
  • Raimund Aschoff
  • Nadine Gharbi
  • Axel Müller
  • Christof Schäfer
  • Marilena Theodorou
  • Hans-Joachim Wypior
  • Hans Geinitz
  • Quality of Life Working Group of the German Radiation Oncology Society (DEGRO)
Original Article

Abstract

Purpose

Published results of quality of life (QoL) studies mostly concern whole brain radiotherapy for limited or multiple brain metastases. This prospective multicentre study was designed to compare the QoL of patients with limited (1–3) brain metastases treated with either whole brain (WBRT) or stereotactic radiotherapy (SRT).

Methods

From 01/2007–03/2011, 90 limited brain metastases patients who were previously untreated (n = 77) or had undergone primary surgery (n = 13) were recruited at 14 centres in Germany and Austria. QoL was measured with the EORTC-QLQ-C15-PAL and BN20 brain modules before the start of radiotherapy and after 3 months.

Results

Fifty-two patients (58%) received WBRT and 38 (42%) received SRT. At 3 months, 67 patients (74%) were still living, and 92.6% of the 3‑month survivors completed the second set of questionnaires. Analysis of the QLQ-C15-PAL and BN20 scales revealed significant deterioration in patients treated with WBRT and SRT in physical function (p < 0.001 and p = 0.007), fatigue (p < 0.001 and p = 0.036), nausea (p = 0.003 and p = 0.002), appetite loss (p < 0.001 and p = 0.025), drowsiness (p < 0.001 and p = 0.011), hair loss (p = 0.019 and p = 0.023) and itchy skin (p = 0.030 and p = 0.018). Motor dysfunction (p < 0.001), communication deficits (p = 0.002) and leg weakness (p < 0.001) declined significantly only in patients treated with WBRT. Comparing the two radiotherapy techniques over time, the results showed significant differences in symptom scores for future uncertainty, fatigue and appetite loss.

Conclusions

QoL data as an outcome of the paper should be considered in decision making on the irradiation technique in patients with small number of brain metastases. Larger studies are required to verify the results according to subgroups.

Keywords

Brain tumours EORTC-QLQ-C15-PAL EORTC-BN20 Stereotactic radiotherapy 

Lebensqualität bei Patienten mit begrenzten (1–3) Hirnmetastasen, die eine stereotaktische oder Ganzhirnbestrahlung erhalten

Eine prospektive Studie der DEGRO AG Lebensqualität

Zusammenfassung

Hintergrund

Bisher publizierte Ergebnisse von Studien zur Lebensqualität (LQ) berücksichtigten überwiegend die Ganzhirnbestrahlung (GHRT) für limitierte und multiple Hirnmetastasen. In dieser prospektiven, multizentrischen Studie wurde die LQ von Patienten mit limitierten (1–3) Hirnmetastasen, die entweder mit GHRT oder stereotaktischer Bestrahlung (SRT) behandelt wurden, verglichen.

Patienten und Methoden

Von 01/2007–03/2011 wurden 90 Patienten mit bisher unbehandelten (n = 77) oder primär chirurgisch versorgten (n = 13) limitierten Hirnmetastasen an 14 Zentren in Deutschland und Österreich rekrutiert. Die LQ wurde mit dem EORTC-QLQ-C15-PAL und dem Hirn-Modul BN20 vor Beginn der Strahlentherapie und 3 Monate danach gemessen.

Ergebnisse

52 Patienten (58 %) erhielten eine GHRT und 38 (42 %) eine SRT. Nach 3 Monaten lebten noch 67 (74 %) Patienten. 92,6 % der 3‑Monats-Überlebenden vervollständigten das zweite Fragebogenset. Die Auswertung bezüglich der QLQ-C15-PAL- und BN20-Skalen zeigten eine signifikante Verschlechterung sowohl bei Patienten mit GHRT als auch mit SRT in der physikalischen Funktion (p < 0,001 und p = 0,007), Fatigue (p < 0,001 und p = 0,036), Übelkeit (p = 0,003 und p = 0,002), Appetitverlust (p < 0,001 und p = 0,025), Schwindel (p < 0,001 und p = 0,011), Haarverlust (p = 0,019 und p = 0,023) und Juckreiz (p = 0,030 und p = 0,018). Die motorische Dysfunktion (p < 0,001), Kommunikationsdefizite (p = 0,002) und Beinschwäche (p < 0,001) verschlechterten sich signifikant nur bei Patienten mit GHRT. Beim Vergleich beider Bestrahlungstechniken im zeitlichen Verlauf, zeigten die Ergebnisse signifikante Unterschiede in den Symptomskalen für Zukunftsangst, Fatigue und Appetitverlust.

Schlussfolgerung

Die Daten zur LQ in dieser Untersuchung können helfen, über die Bestrahlungstechnik bei Patienten mit limitierten Hirnmetastasen zu entscheiden.

Größere Studien sind nötig um die Ergebnisse für einzelne Subgruppen zu verifizieren.

Schlüsselwörter

Hirntumore EORTC-QLQ-C15-PAL EORTC-BN20 Stereotaktische Radiotherapie 

Notes

Acknowledgements

We thank A. Bayerl, U. Eichenseder-Seiss, J. Hagg, M. Hipp, F. Zehentmayr, S. Sehlen, T. Bölling, B. van Oorschot, E. Bosch, I. Kleff, F. Bruns and J. Gerstein for their good ideas in initiation and analysis of this study and helping to recruit patients.

Funding

The study was supported by a foundation of the Equal Opportunities Office of the Medical School Hannover.

Compliance with ethical guidelines

Conflict of interest

D. Steinmann, D. Vordermark, W. Gerstenberg, R. Aschoff, N. Gharbi, A. Müller, C. Schäfer, M. Theodorou, H.-J. Wypior and H. Geinitz declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Diana Steinmann
    • 1
    Email author
  • Dirk Vordermark
    • 2
  • Wiebke Gerstenberg
    • 1
    • 3
  • Raimund Aschoff
    • 4
  • Nadine Gharbi
    • 5
    • 6
  • Axel Müller
    • 5
  • Christof Schäfer
    • 7
  • Marilena Theodorou
    • 5
  • Hans-Joachim Wypior
    • 8
  • Hans Geinitz
    • 9
  • Quality of Life Working Group of the German Radiation Oncology Society (DEGRO)
  1. 1.Department of Radiotherapy and Special OncologyMedical School HannoverHannoverGermany
  2. 2.Department of Radiation OncologyMartin Luther University Halle-WittenbergHalle (Saale)Germany
  3. 3.Department for Dermatology and AllergologyHelios Klinikum Berlin-BuchBerlinGermany
  4. 4.Strahlentherapie 360°Praxis am Sana-Klinikum DuisburgDuisburgGermany
  5. 5.Department of Radiation OncologyTU MünchenMunichGermany
  6. 6.Medical Faculty, Department of Radiation Oncology, CyberKnife- and Radiation TherapyUniversity of CologneCologneGermany
  7. 7.Department of Radiation OncologySt. Elisabeth Hospital StraubingStraubingGermany
  8. 8.Department of Radiation OncologyHospital LandshutLandshutGermany
  9. 9.Department of Radiation Oncology, Krankenhaus Barmherzige Schwestern Linz and Medical FacultyJohannes Kepler University LinzLinzAustria

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