P18.16 Changes in health-related quality of life and neurocognitive functioning in individual patients treated with stereotactic radiotherapy for brain metastases
Authors: P. B. van der Meer, E. J. J. Habets, L. Dirven, R. G. Wiggenraad, A. Verbeek-de Kanter, H. Zwinkels, M. Klein, M. J. B. Taphoorn
Journal: Neuro-Oncology (2017)

Background: Stereotactic radiotherapy (SRT) is believed to result in a similar survival rate as whole-brain radiotherapy for treatment of brain metastases, with a less profound impact on cognition and health-related quality of life (HRQoL). Recently it has been shown that, on group level, brain metastases patients treated with SRT maintain their pre-treatment levels of cognition and HRQoL. Although stable on group level, this may not hold true for individual patients. Objective: We sought to evaluate changes in cognition and HRQoL on the individual patient level three and six months after SRT. Methods: A total of 55 patients completed HRQoL questionnaires and underwent neurocognitive testing prior to SRT and 3 and/or 6 months after SRT. The EORTC QLQ-C30 and BN20 questionnaires were used to assess HRQoL and a standardized test battery to assess neurocognitive functioning. Changes in HRQoL and cognition were evaluated on (1) a scale/domain level and (2) patient level. First, percentage of patients showing a clinically relevant improvement, stable score or deterioration on each of 8 predetermined HRQoL scales and 7 cognitive domains were calculated. Next, patients were categorized into 4 groups, separately for HRQoL and cognition: decline (only worsening of HRQoL or cognition), both (decline and improvement), stable (no detectable change in any scale/domain) and improvement (only improvement). Results: Three months after SRT, a decline in the 8 different HRQOL scales was observed in 16-61% of the patients, while 20-71% remained stable and 16-40% improved. Six months after SRT, 8-47% of the patients had worse scores on the 8 HRQoL scales, 18-75% the same scores and 11-34% better scores. On the 7 different neurocognitive functioning domains, only 3-8% of the patients worsened, 78-100% remained stable, while 3-17% showed an improvement three months after SRT. These percentages were similar six months after SRT; 8-20% of the patients deteriorated on the 7 domains, 73-100% remained stable and 4-8% improved. Changes in HRQoL and cognition on patient level were evaluated for two different time periods (0-3 months and 3-6 months). For HRQoL, 22% and 21% of the patients worsened in the period 0-3 and 3-6 months respectively, 64% and 58% both improved and deteriorated, 2% and 3% were stable and 12% and 18% showed improvement only. For cognition, the percentages were as follows: 14% and 33% showed a decline only, 6% and 4% both a decline and improvement, 67% and 50% stable scores and 14% and 13% an improvement only. Conclusion: In line with the results at group level, most brain metastases patients treated with SRT maintained their pre-treatment levels of cognition for at least 6 months. In contrast, changes in HRQoL scores for the different scales differed considerably on an individual patient level, and most patients showed both deterioration and improvement in various HRQoL scales in the first 6 months after SRT.