Quality of life is a predictor of survival in patients with brain mets, according to prospective study
QOL scores improved for 72.3 percent of patients from baseline to 12 months for patients with a brain mets total volume of ≤ 5 cm3 – Patient-reported QOL is a predictor of survival in patients with brain mets and may be helpful in deciding on the optimal treatment – Gamma Knife radiosurgery delivers the lowest dose to the healthy brain than any radiosurgery device on the market
When dealing with a lower brain metastasis burden, patients who received Gamma Knife® radiosurgery reported higher quality of life (QOL) scores than patients with a higher tumor volume. In a recent study published in the Journal of Neurosurgery, researchers also found that QOL is a predictor of survival.
Lung cancer patients who develop brain mets have a poor prognosis, making estimations of survival and risk of treatment-related QOL deterioration important when deciding on treatment. The study by S Bragstad, et. al aimed to evaluate changes in QOL following Gamma Knife radiosurgery for these patients.
Forty-eight consecutive lung cancer patients with brain mets received GKS during May 2010 to September 2011, and their QOL was prospectively assessed before and 1, 3, 6, 9 and 12 months post-Gamma Knife radiosurgery by using the Functional Assessment of Cancer Therapy-Brain (FACT-BR) questionnaire.
The key findings were:
- QOL scores according to the brain cancer subscale (BRCS) of the FACT-BR improved for 72.3 percent of patients from baseline to 12 months for patients with a brain mets total volume of ≤ 5 cm3
- Patients with a tumor burden ≥ 5cm3 showed a steady decline in BRCS scores over the same period
- Patient median survival post-Gamma Knife radiosurgery was 5.6 months
- Patients with a higher BRCS score, higher Karnofsky Performance Score (at baseline), female gender, and absence of liver, adrenal and bone mets predicted longer survival
The study concluded that patient-reported QOL is a predictor of survival in patients with brain mets and may be helpful in deciding on the optimal treatment. The investigators also noted that Gamma Knife radiosurgery is a safe and effective therapeutic modality for lung cancer patients with a brain mets volume of ≤ 5 cm3 at treatment.
According to Anna Britten, MD, Director, Global Medical Managers and Global Clinical Consortia, Office of Medical Affairs at Elekta, it is known that patients with a lower brain mets tumor burden and fewer extracranial distant mets present with a higher performance score and ultimately QOL at baseline than a patient with more advanced disease.
“The study shows that patients can maintain and experience improved QOL scores over the course of treatment and post-treatment with Gamma Knife radiosurgery,” she says. “Patients with more advanced disease and a higher brain mets tumor burden will often see a decline in their QOL due to worsening of their systemic disease, but not due to Gamma Knife surgery. Gamma Knife radiosurgery delivers the lowest dose to the healthy brain than any radiosurgery device on the market. We often hypothesize that this critical dosimetric feature will allow patients to maintain a high QOL over the course of treatment when compared to other radiosurgery devices.
“While this study does not actually compare Gamma Knife systems to other radiosurgery platforms,” she continues, “we can say definitively that patients with a reasonable tumor burden can enjoy a significant QOL enhancement during and after Gamma Knife radiosurgery for a very aggressive disease.”
- Bragstad S, Flatebø Natvig GK, et. al. Predictors of quality of life and survival following Gamma Knife surgery for lung cancer brain metastases: a prospective study. J Neurosurg 2017 Aug 18:13 doi: 10.3171/2017.2.JNS161659.