Pham Duy Q, Sheehan Darrah E, Sheehan Kimball A, Katsos Konstantinos, Fadul Camilo E
University of Virginia School of Medicine, Charlottesville, Virginia, USA.
University of Virginia School of Medicine Inova Campus, 3300 Gallows Road, Falls Church, VA, 22042, USA.
J Neurooncol. 2025 Jan;171(2):383-391. doi: 10.1007/s11060-024-04854-5. Epub 2024 Oct 21.
Stereotactic radiosurgery (SRS) is frequently used in the management of brain metastasis patients. However, there is an urgent need to evaluate post-treatment outcomes and quality of life metrics for patients undergoing SRS for brain metastases.
The NeuroPoint Alliance (NPA) SRS Quality Registry conducted prospective enrollment of patients undergoing SRS from 2017 to 2024. Patients with brain metastases from lung cancer, breast cancer, and melanoma were included in the analysis. Outcomes of interest included quality of life metrics, as captured by the five-dimension Euro-QOL (EQ-5D) at 6-12 months and last record follow-up, overall survival, local progression, out-of-field progression, and overall intracranial progression.
522 patients comprised our analytic cohort, and 315 patients had available EQ-5D data at the time of SRS and final follow-up. 264 (47.8%), 197 (35.7%), and 91 (16.5%) patients had 1, 2-4, and 5-14 lesions pre-SRS, respectively. The median overall survival time from diagnosis was 27.3 months. The median time-to-local progression was not reached. At final follow-up, 107 (34.0%) patients had improvement, 51 (16.2%) patients had stable, and 113 patients (35.9%) had worsening EQ-5D scores when compared to baseline. For 44 (13.9%) patients mixed responses across the EQ-5D indices were reported. Linear regression analysis showed that male sex, smoking status, primary tumor type, time-to-overall progression, cumulative intracranial tumor volume (CITV), and baseline EQ-5D were statistically significantly associated with EQ-5D single index at the final follow-up.
Real-world data from the SRS NPA Registry demonstrated that most patients with brain metastasis had no change or improvement in quality of life after SRS. Baseline EQ-5D was predictive of EQ-5D single index at final follow-up, and, as such, EQ-5D at baseline would be a valuable assessment measure for brain metastasis patients undergoing SRS.
立体定向放射外科（SRS）常用于脑转移瘤患者的治疗。然而，迫切需要评估接受SRS治疗脑转移瘤患者的治疗后结局和生活质量指标。
神经点联盟（NPA）SRS质量登记处对2017年至2024年接受SRS治疗的患者进行了前瞻性登记。分析纳入了肺癌、乳腺癌和黑色素瘤脑转移患者。感兴趣的结局包括生活质量指标，通过6至12个月时的五维度欧洲生活质量量表（EQ-5D）以及最后记录的随访进行评估，还包括总生存期、局部进展、野外进展和颅内总体进展。
522例患者组成了我们的分析队列，315例患者在SRS时和最终随访时有可用的EQ-5D数据。264例（47.8%）、197例（35.7%）和91例（16.5%）患者在SRS前分别有1个、2至4个和5至14个病灶。从诊断开始的总生存期的中位数为27.3个月。未达到局部进展的中位时间。在最终随访时，与基线相比，107例（34.0%）患者有改善，51例（16.2%）患者稳定，113例（35.9%）患者的EQ-5D评分恶化。有44例（13.9%）患者报告了EQ-5D各指标的混合反应。线性回归分析表明，男性、吸烟状况、原发肿瘤类型、总体进展时间、累积颅内肿瘤体积（CITV）和基线EQ-5D在最终随访时与EQ-5D单一指标在统计学上显著相关。
SRS NPA登记处的真实世界数据表明，大多数脑转移瘤患者在SRS后生活质量没有变化或有所改善。基线EQ-5D可预测最终随访时的EQ-5D单一指标，因此，基线时的EQ-5D对于接受SRS治疗的脑转移瘤患者将是一项有价值的评估指标。
