Open Access Highly Accessed Research article

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

Diana Steinmann1*, Yvonne Paelecke-Habermann2, Hans Geinitz3, Raimund Aschoff4, Anja Bayerl5, Tobias Bölling6, Elisabeth Bosch7, Frank Bruns1, Ute Eichenseder-Seiss5, Johanna Gerstein8, Nadine Gharbi3, Juliane Hagg9, Matthias Hipp10, Irmgard Kleff11, Axel Müller3, Christof Schäfer10, Ursula Schleicher7, Susanne Sehlen12, Marilena Theodorou3, Hans-Joachim Wypior13, Franz Zehentmayr14, Birgitt van Oorschot15 and Dirk Vordermark16

Author Affiliations

1 Radiation Oncology, Medical School Hannover, Hannover, Germany

2 Radiation Oncology, Martin Luther University, Halle/Saale, Germany

3 Radiation Oncology, TU München, München, Germany

4 Radiation Oncology, St.-Josef-Hospital Gelsenkirchen-Horst, Gelsenkirchen, Germany

5 Radiation Oncology Radiation Oncology, Hospital Krems, Krems, Austria

6 Radiation Oncology, University of Münster, Münster, Germany

7 Radiation Oncology, Hospital Düren, Düren, Germany

8 Radiation Oncology, University of Frankfurt/Main, Frankfurt/Main, Germany

9 Radiation Oncology, University of Ulm, Ulm, Germany

10 Radiation Oncology, University of Regensburg, Regensburg, Germany

11 Radiation Oncology, Hospital Traunstein, Traunstein, Germany

12 Radiation Oncology, LMU München, München, Germany

13 Radiation Oncology, Hospital Landshut, Landshut, Germany

14 Radiation Oncology, Hospital Salzburg, Salzburg, Austria

15 Radiation Oncology, University of Würzburg, Würzburg, Germany

16 Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany

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BMC Cancer 2012, 12:283  doi:10.1186/1471-2407-12-283

Published: 10 July 2012

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.

Keywords:
Brain tumours; EORTC-QLQ-C15-PAL; EORTC-BN20; Whole-brain radiotherapy