WHOle Brain Irradiation or STEreotactic Radiosurgery for five or more brain metastases (WHOBI-STER): a prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

In the past, detection of brain metastases signaled the conclusion of aggressive systemic treatment and shifted the focus of care toward palliation. The median survival for patients with single brain metastasis without brain-directed treatment is about a month. Whole brain radiation therapy was the traditional palliative treatment utilized, offering an additional 2 to 5 months. More recently, in addition to whole brain irradiation, the roles of surgery, stereotactic radiosurgery, chemotherapy, and targeted therapies in the definitive management of brain metastases have been investigated in numerous studies. In selected patients, the use of aggressive local therapies can be associated with long survival and good quality of life. This chapter discusses the current state of the art therapeutic options for brain metastases.

Download Full-text

Health-Related Quality of Life following Fractionated Stereotactic Radiosurgery for Large Brain Metastases Resection Cavities on a Phase I/II Trial

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2020.07.2207 ◽

2020 ◽

Vol 108 (3) ◽

pp. S68-S69

Author(s):

E. Rahimy ◽

S.A. Dudley ◽

R. Von Eyben ◽

E. Pollom ◽

S.G. Soltys

Keyword(s):

Quality Of Life ◽

Brain Metastases ◽

Phase I ◽

Stereotactic Radiosurgery ◽

Health Related Quality ◽

Large Brain ◽

Related Quality ◽

Health Related ◽

Fractionated Stereotactic Radiosurgery

Download Full-text

Long Survival in a Patient with Brain Metastases from Breast Cancer

Clinical medicine Oncology ◽

10.4137/cmo.s317 ◽

2008 ◽

Vol 2 ◽

pp. CMO.S317

Author(s):

G Sanna ◽

G Petralia ◽

M Cossu Rocca ◽

C Marenghi ◽

F Nolè

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Brain Metastases ◽

Karnofsky Performance Status ◽

Performance Status ◽

Good Control ◽

Short Report ◽

Whole Brain Irradiation ◽

Her Family

The incidence of brain metastases (BMs) is apparently rising in patients with advanced breast cancer, possibly due to better therapeutic approaches for control of metastatic growth in other organs. Occurrence of BMs severely affects quality of life and is associated with dire prognosis. In this short report we describe the clinical case of a 47 year old woman, with BMs from breast cancer diagnosed in May 2001. The patient was treated with whole brain irradiation and radiosurgery, with initial control of BMs. Due to previous radiotherapy fields and doses, further local treatments are not feasible anymore. Since September 2006, the patient has been receiving systemic therapy with Lapatinib at the dose of 1500 mg/die continuously, with a good control of cerebral, liver and nodal metastasis after one year of treatment (September 2007). Her quality of life is acceptable, her Karnofsky Performance Status (KPS) is more than 70%, and she takes care of her family, and has not experienced neuro-cognitive dysfunction.

Download Full-text

Management of Patients with ≥4 Brain Metastases Using Stereotactic Radiosurgery Boost after Whole Brain Irradiation

Tumori Journal ◽

10.1177/1578.17210 ◽

2014 ◽

Vol 100 (3) ◽

pp. 302-306 ◽

Cited By ~ 5

Author(s):

Ferrat Dincoglan ◽

Omer Sager ◽

Hakan Gamsiz ◽

Bora Uysal ◽

Selcuk Demiral ◽

...

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Whole Brain Irradiation ◽

Whole Brain ◽

Brain Irradiation

Download Full-text

Quality of Life following Stereotactic Radiosurgery for Single and Multiple Brain Metastases

Neurosurgery ◽

10.1093/neuros/nyw166 ◽

2017 ◽

Vol 81 (1) ◽

pp. 147-155 ◽

Cited By ~ 11

Author(s):

Jacob A. Miller ◽

Rupesh Kotecha ◽

Gene H. Barnett ◽

John H. Suh ◽

Lilyana Angelov ◽

...

Keyword(s):

Quality Of Life ◽

Brain Metastasis ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Minimum Clinically Important Difference ◽

Clinically Important Difference ◽

Patient Health ◽

Appropriate Therapy

Abstract BACKGROUND: Given the neurological morbidity and poor prognosis associated with brain metastases, it is critical to deliver appropriate therapy while remaining mindful of patient quality of life (QOL). For many patients, stereotactic radiosurgery (SRS) effectively controls intracranial disease, but QOL outcomes have not been characterized. OBJECTIVE: To determine the effect of number of brain metastases upon QOL preservation following SRS. METHODS: The EuroQol 5 Dimensions questionnaire (EQ-5D) and Patient Health Questionnaire 9 instruments were prospectively collected from a cohort of patients undergoing SRS for brain metastasis between 2008 and 2015. These instruments served as measures of overall QOL and depression. QOL deterioration exceeding the minimum clinically important difference was considered failure. Freedom from 12-month EQ-5D index failure was the primary outcome. RESULTS: One hundred and twenty-two SRS treatments (67 patients, 421 lesions) were eligible for inclusion. Intracranial failure (local or distant) occurred following 61% of treatments. Among 421 lesions, 8% progressed locally. Median follow-up was 12 months. All subscores of the EQ-5D instrument expectantly worsened at last follow-up; however, the magnitude of this difference (0.079) did not exceed the EQ-5D index minimum clinically important difference (mean 0.752 vs 0.673, P < .01). Twelve-month EQ-5D index QOL preservation was 79%. Patients with more than 3 brain metastases had a greater rate of EQ-5D index deterioration (hazard ratio 4.14, P < .01) than those with a single metastasis. CONCLUSIONS: Among patients with brain metastasis, QOL preservation must remain paramount as multimodality therapy continues to improve. In the present investigation, 12-month QOL preservation was 79%. However, patients with more than 3 brain metastases were at significantly greater risk for QOL decline.

Download Full-text