Quality of life in patients with limited (1-3) brain metastases undergoing stereotactic or whole brain radiotherapy

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.