QL-11HEALTH-RELATED QUALITY OF LIFE COGNITIVE FUNCTIONING AND SURVIVAL IN PATIENTS TREATED WITH STEREOTACTIC RADIOTHERAPY FOR BRAIN METASTASES: A PROSPECTIVE STUDY

摘要

BACKGROUND: Although stereotactic radiotherapy (SRT) for brain metastases is expected to have a less detrimental effect on cognition and health-related quality of life (HRQoL) than whole-brain radiotherapy (WBRT), the precise effect is largely unknown. METHODS: Cognition and HRQoL were measured prior to SRT, 3 and 6 months follow-up. Four cognitive domains and seven preselected scales of the EORTC-QLQC30 and BN20 were analysed. Survival analysis was performed and effect of total volume of brain metastases and Karnofsky Performance Status (KPS) (both categorized) on overall survival (OS) was examined. Linear mixed models were used to analyse cognition and HRQoL over time, also separately for KPS and tumor volume. RESULTS: Mean age of the 97 patients was 63 years, median OS was 7.7 months. Median OS was significantly shorter for KPS < 90 compared to KPS ≥ 90 and for large compared to smaller tumor volume. Prior to SRT, memory and attention were worse compared to matched healthy controls, and all HRQoL scores were lower than of the general population. On group level, patients worsened in physical functioning after 6 months follow-up. Cognitive domain scores did not change over 6 months. Mean HRQoL scores over 6 months time were significantly lower for patients with baseline KPS < 90 compared to KPS ≥ 90 for physical, cognitive and role functioning, and motor dysfunction. Mean physical and cognitive functioning over time were lower for large than for smaller tumors. Information processing speed over time was worse for patients with KPS < 90 than KPS ≥ 90, and for large tumor volume compared to small volumes. CONCLUSION: Before SRT, cognitive functioning and HRQoL are moderately impaired in patients with brain metastases. Low KPS and large tumor volume are associated with shorter survival and worse cognition and HRQoL. Over time, SRT does not have a detrimental effect on cognition and HRQoL, suggesting that SRT should be preferred over WBRT.