Quality of Radiomics Research on Brain Metastasis: A Roadmap to Promote Clinical Translation

Brain metastases (BMs) are cancer cells that spread to the brain from primary tumors in other organs. Up to 35% of adult cancer patients develop BMs. The treatment of BM patients who have well-controlled extracranial disease and a small number of lesions consists of localized doses of radiation (stereotactic radio surgery (SRS)). Estimating prognosis among BM patients may allow treatments to be chosen that balance durability of intracranial tumor control with quality of life and the side effects of treatment. No mathematical model-based quantitative biomarkers have been determined for estimating prognosis. As a first step toward that goal, we describe a mathematical model of growth and response of brain metastasis to stereotactic radio surgery. The mathematical model incorporates some biological mechanisms involved in BM growth and response to SRS and allows the observed dynamics to be accurately described.

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Quality of Life, Psychological Burden, and Sleep Quality in Patients With Brain Metastasis Undergoing Whole Brain Radiation Therapy

Clinical Journal of Oncology Nursing ◽

10.1188/16.cjon.ae-02 ◽

2016 ◽

Vol 20 (5) ◽

pp. AE-02 ◽

Cited By ~ 6

Author(s):

Fatma Teke ◽

Pakize Bucaktepe ◽

Erkan Kıbrıslı ◽

Melike Demir ◽

Aslıhan Ibiloglu ◽

...

Keyword(s):

Quality Of Life ◽

Radiation Therapy ◽

Brain Metastasis ◽

Sleep Quality ◽

Whole Brain Radiation Therapy ◽

Whole Brain ◽

Psychological Burden ◽

Whole Brain Radiation ◽

Brain Radiation

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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.

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Quality of life outcomes for brain metastasis patients treated with stereotactic radiosurgery: pre-procedural predictive factors from a prospective national registry

Journal of Neurosurgery ◽

10.3171/2018.8.jns181599 ◽

2019 ◽

Vol 131 (6) ◽

pp. 1848-1854 ◽

Cited By ~ 4

Author(s):

Jason P. Sheehan ◽

Inga Grills ◽

Veronica L. Chiang ◽

Huamei Dong ◽

Arthur Berg ◽

...

Keyword(s):

Quality Of Life ◽

Brain Metastasis ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

National Registry ◽

Karnofsky Performance Scale ◽

Linear Regression Models ◽

Anxiety Depression

OBJECTIVEStereotactic radiosurgery (SRS) is increasingly used for the treatment of brain metastasis. To date, most studies have focused on survival, radiological response, or surrogate quality endpoints such as Karnofsky Performance Scale status or neurocognitive indices. The current study prospectively evaluated pre-procedural factors impacting quality of life in brain metastasis patients undergoing SRS.METHODSUsing a national, cloud-based platform, patients undergoing SRS for brain metastasis were accrued to the registry. Quality of life prior to SRS was assessed using the 5-level EQ-5D (EQ5D-L) validated tool; additionally, patient and treatment attributes were collected. Patient quality of life was assessed as part of routine follow-up after SRS. Factors predicting a difference in the aggregate EQ5D-L score or the subscores were evaluated. Pre-SRS covariates impacting changes in EQ5D-L were statistically evaluated. Statistical analyses were conducted using multivariate linear regression models.RESULTSEQ5D-L results were available for 116 patients. EQ5D-L improvement (average of 0.387) was noted in patients treated with earlier SRS (p = 0.000175). Worsening overall EQ5D-L (average of 0.052 per lesion) was associated with an increased number of brain metastases at the time of initial presentation (p = 0.0399). Male sex predicted a risk of worsening (average of 0.347) of the pain and discomfort subscore at last follow-up (p = 0.004205). Baseline subscores of pain/discomfort were not correlated with pain/discomfort subscores at follow-up (p = 0.604), whereas baseline subscores of anxiety/depression were strongly positively correlated with the anxiety/depression follow-up subscores (p = 0.0039).CONCLUSIONSAfter SRS, quality of life was likely to improve in patients treated early with SRS and worsen in those with a greater number of brain metastases. Sex differences appear to exist regarding pain and discomfort worsening after SRS. Those with high levels of anxiety and depression at SRS may benefit from medical treatment as this particular quality of life factor generally remains unchanged after SRS.

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