O9.05 * COGNITIVE FUNCTIONING, HEALTH-RELATED QUALITY OF LIFE AND SURVIVAL AFTER STEREOTACTIC RADIOTHERAPY IN PATIENTS WITH BRAIN METASTASES
Authors: E. J. J. Habets, L. Dirven, R. Wiggenraad, H. Zwinkels, G. J. Lycklamaa Nijeholt, M. J. B. Taphoorn
Journal: Neuro-Oncology (2014)

INTRODUCTION: Stereotactic radiotherapy (SRT) is the current treatment of choice in patients with one to three brain metastases. Although survival rates are assumed to be similar, SRT is expected to have a less detrimental effect on cognition and health-related quality of life (HRQoL) than whole-brain radiotherapy (WBRT). OBJECTIVE: To prospectively study the impact of SRT on HRQoL and cognitive functioning in patients with brain metastatic disease. METHODS: A total of 97 patients were included prior to SRT treatment. Cognitive functioning and HRQoL were measured at baseline, 3 and 6 months follow-up. Cognition was measured with tests covering 4 domains (verbal and working memory, information processing speed and attention) and compared to matched healthy controls. HRQoL was assessed with the EORTC-QLQC30 and BN20. Seven scales were analysed: physical, cognitive, emotional and role functioning, global quality of life, motor and communication deficits. Fatigue was assessed with the Fatigue Severity Scale. 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 tumour volume. RESULTS: Mean age of patients was 63 years, median OS was 7.7 months. Six months survival rate was 60%. Median OS was significantly shorter for KPS < 90 compared to KPS ≥ 90 (5.5 vs 11.1 months) and for large compared to smaller tumour volume (4.5 vs 9.3 months). Prior to SRT, 3 out of 4 cognitive domains (verbal and working memory, attention) were worse compared to controls, and all HRQoL scores were lower than of the general population. On group level, patients worsened in physical functioning (-14; p = 0.03) and fatigue (10; p = 0.001) after 6 months follow-up, while other HRQoL scales did not significantly change over time. 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 patients with KPS ≥90 for physical (54 vs 74; p < 0.001), cognitive (75 vs 85; p = 0.03) and role functioning (46 vs 70; p < 0.001), motor dysfunction (21 vs 8; p = 0.006) and fatigue (37 vs 29; p = 0.02). Mean physical and cognitive functioning over time were lower for large than for smaller tumour volumes. Information processing speed over time was worse for patients with KPS <90 than KPS ≥90 (-0.6 vs 0.5; p = 0.002), and for large tumour volume compared to small or medium volumes (-1.1 vs 0.2 vs 0.3; p = 0.02). CONCLUSION: Before SRT, cognitive functioning and HRQoL are moderately impaired in patients with brain metastases. Low KPS and large tumour volume are associated with shorter survival and worse cognitive functioning and HRQoL. Over time, SRT does not have a detrimental effect on cognition and HRQoL, suggesting that SRT should be preferred over WBRT.