Miller Jacob A, Kotecha Rupesh, Barnett Gene H, Suh John H, Angelov Lilyana, Murphy Erin S, Vogelbaum Michael A, Mohammadi Alireza, Chao Samuel T
Cleveland Clinic Lerner College of Medi-cine, Cleveland Clinic, Cleveland, Ohio.
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Neurosurgery. 2017 Jul 1;81(1):147-155. doi: 10.1093/neuros/nyw166.
Given the neurological morbidity and poor prognosis associated with brain metastases, it is critical to deliver appropriate therapy while remaining mindful of patient quality of life (QOL). For many patients, stereotactic radiosurgery (SRS) effectively controls intracranial disease, but QOL outcomes have not been characterized.
To determine the effect of number of brain metastases upon QOL preservation following SRS.
The EuroQol 5 Dimensions questionnaire (EQ-5D) and Patient Health Questionnaire 9 instruments were prospectively collected from a cohort of patients undergoing SRS for brain metastasis between 2008 and 2015. These instruments served as measures of overall QOL and depression. QOL deterioration exceeding the minimum clinically important difference was considered failure. Freedom from 12-month EQ-5D index failure was the primary outcome.
One hundred and twenty-two SRS treatments (67 patients, 421 lesions) were eligible for inclusion. Intracranial failure (local or distant) occurred following 61% of treatments. Among 421 lesions, 8% progressed locally. Median follow-up was 12 months.
Among patients with brain metastasis, QOL preservation must remain paramount as multimodality therapy continues to improve. In the present investigation, 12-month QOL preservation was 79%. However, patients with more than 3 brain metastases were at significantly greater risk for QOL decline.
鉴于脑转移瘤相关的神经功能障碍及预后不良，在关注患者生活质量（QOL）的同时提供恰当治疗至关重要。对许多患者而言，立体定向放射外科（SRS）能有效控制颅内疾病，但生活质量结局尚未得到明确描述。
确定脑转移瘤数量对SRS后生活质量保留情况的影响。
前瞻性收集了2008年至2015年间接受SRS治疗脑转移瘤的一组患者的欧洲五维健康量表问卷（EQ-5D）和患者健康问卷9。这些工具用作总体生活质量和抑郁的测量指标。生活质量恶化超过最小临床重要差异被视为失败。12个月内无EQ-5D指数失败是主要结局。
122次SRS治疗（67例患者，421个病灶）符合纳入标准。61%的治疗后出现颅内失败（局部或远处）。在421个病灶中，8%出现局部进展。中位随访时间为12个月。
在脑转移瘤患者中，随着多模式治疗不断改善，生活质量保留必须始终是首要考虑的。在本研究中，12个月的生活质量保留率为79%。然而，脑转移瘤超过3个的患者生活质量下降风险显著更高。
