1Department of Neurological Surgery, University of Virginia Health System; and.
2School of Medicine, University of Virginia, Charlottesville, Virginia.
J Neurosurg. 2020 Jul 10;134(6):1791-1799. doi: 10.3171/2020.4.JNS20788. Print 2021 Jun 1.
Quality of life (QOL) is an important endpoint measure of cancer treatment. The authors' goal was to evaluate QOL trajectories and prognostic value in cancer patients treated with stereotactic radiosurgery (SRS) for brain metastases.
Patients who underwent Gamma Knife radiosurgery (GKRS) between January 2016 and November 2019 were prospectively evaluated for QOL using the EQ-5D-3L questionnaire before SRS and at follow-up visits. Only patients who had pre-SRS and at least 1 post-SRS QOL assessment were considered.
Fifty-four cancer patients underwent 109 GKRS procedures. The first post-SRS visit was at a median of 2.59 months (range 0.13-21.08 months), and the last post-SRS visit was at 14.72 months (range 2.52-45.21 months) after SRS. There was no statistically significant change in the EQ-5D index score (p = 0.539) at the first compared with last post-SRS visit. The proportion of patients reporting some problems on the EQ-5D dimension of self-care increased during the course of follow-up from 9% (pre-SRS visit) to 18% (last post-SRS visit; p = 0.03). The proportion of patients reporting problems on the EQ-5D dimensions of mobility, usual activities, pain/discomfort, and anxiety/depression remained stable during the course of follow-up (p ≥ 0.106). After adjusting for clinical variables, a higher recursive partitioning analysis (RPA) class (i.e., worse prognostic category) was independently associated with greater odds for EQ-5D index score deterioration (p = 0.050). Upfront whole-brain radiation therapy predicted deterioration of the EQ-5D self-care (p = 0.03) and usual activities (p = 0.024) dimensions, while a greater number of lesions predicted deterioration of the EQ-5D anxiety/depression dimension (p = 0.008). A lower pre-SRS EQ-5D index was associated with shorter survival independently from clinical and demographic variables (OR 18.956, 95% CI 2.793-128.64; p = 0.003).
QOL is largely preserved in brain metastasis patients treated with SRS. Higher RPA class, upfront whole-brain radiation therapy, and greater intracranial disease burden are independent predictors of post-SRS QOL deterioration. Worse pre-SRS QOL predicts shorter survival. Assessment of QOL is recommended in brain metastasis patients managed with SRS.
生活质量（QOL）是癌症治疗的一个重要终点衡量指标。作者的目标是评估接受立体定向放射外科（SRS）治疗脑转移瘤的癌症患者的 QOL 轨迹和预后价值。
2016 年 1 月至 2019 年 11 月期间，对接受伽玛刀放射外科（GKRS）治疗的患者前瞻性地使用 EQ-5D-3L 问卷评估 QOL，在 SRS 前和随访时进行评估。仅考虑了在 SRS 前有评估且至少有 1 次 SRS 后 QOL 评估的患者。
54 例癌症患者接受了 109 次 GKRS 治疗。首次 SRS 后随访时间中位数为 2.59 个月（范围 0.13-21.08 个月），末次 SRS 后随访时间为 14.72 个月（范围 2.52-45.21 个月）。与末次 SRS 后随访相比，首次 SRS 后随访时 EQ-5D 指数评分无统计学显著变化（p=0.539）。在随访过程中，自我护理的 EQ-5D 维度报告有问题的患者比例从 9%（SRS 前）增加到 18%（末次 SRS 后；p=0.03）。在随访过程中，移动、日常活动、疼痛/不适和焦虑/抑郁的 EQ-5D 维度报告有问题的患者比例保持稳定（p≥0.106）。在校正临床变量后，更高的递归分区分析（RPA）分级（即预后较差的类别）与 EQ-5D 指数评分恶化的可能性更大独立相关（p=0.050）。 upfront 全脑放疗预测 EQ-5D 自我护理（p=0.03）和日常活动（p=0.024）维度的恶化，而更多的病变预测 EQ-5D 焦虑/抑郁维度的恶化（p=0.008）。SRS 治疗后，较低的预 SRS EQ-5D 指数与较短的生存时间独立相关，与临床和人口统计学变量无关（OR 18.956，95%CI 2.793-128.64；p=0.003）。
SRS 治疗的脑转移瘤患者的 QOL 基本保持。更高的 RPA 分级、 upfront 全脑放疗和更大的颅内疾病负担是 SRS 后 QOL 恶化的独立预测因子。较差的预 SRS QOL 预测较短的生存时间。建议对接受 SRS 治疗的脑转移瘤患者进行 QOL 评估。
