NEW YORK (Reuters Health) – After focal treatment of a limited number of brain metastases, whole-brain radiotherapy (WBRT) appears to have a negative impact on health-related quality of life.
That finding comes from a recently published EORTC (European Organisation for Research and Treatment of Cancer) study of adjuvant WBRT versus observation in patients with 1 to 3 brain metastases from solid tumors, in which health-related quality of life (HRQOL) was a secondary end point.
“Surprisingly, these results suggest that WBRT seems to diminish QOL even while improving disease control,” notes an editorial accompanying the report, in an online issue of the Journal of Clinical Oncology.
The EORTC trial enrolled 359 patients who were assigned to WBRT or observation after undergoing surgery or stereotactic radiosurgery (SRS). While the primary outcome showed improved disease control with WBRT, overall survival in the two arms was similar.
For the current QOL analysis, Dr. Riccardo Soffietti, with the University of Turin, Italy, and colleagues analyzed data derived from two EORTC Quality of Life Questionnaires: C30, which measures functioning, symptoms and global health; and the Brain Cancer Module (BN20) that assesses neurologic function.
The team found that at 9 months, there was a statistically significant and clinically meaningful difference in mean global HRQOL scores favoring the observation group (63.2) compared to the WBRT group (52.2; p=0.0148).
Scores were also significantly better in the observation-only group for physical, role and cognitive function at various time points.
“Consequently,” Dr. Soffietti and colleagues conclude, “observation with close monitoring with magnetic resonance imaging (as done in the EORTC trial) is not detrimental for HRQOL.”
Editorialists Dr. Atif J. Khan, with Rutgers University in Piscataway, New Jersey, and Dr. Adam P. Dicker, at Thomas Jefferson University in Philadelphia, Pennsylvania, note several limitations to the study.
Nonetheless, they comment: “As the first reported QOL study in these patients, it deserves attention when designing the next generation of clinical trials for patients with brain metastasis. Ongoing efforts at improving outcomes include hippocampal avoidance and postoperative SRS boosts.”
SOURCE: On the Merits and Limitations of Whole-Brain Radiation Therapy
