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Radiosurgery With or Without Whole-Brain Radiotherapy for Brain Metastases

The Patients’ Perspective Regarding Complications

Kondziolka, Douglas, MD, MSc, FRCSC; Niranjan, Ajay, MBBS, MCh; Flickinger, John C., MD; Lunsford, L Dade, MD

American Journal of Clinical Oncology: April 2005 - Volume 28 - Issue 2 - p 173-179
doi: 10.1097/01.coc.0000143016.15783.5b
Original Article: Central Nervous System

Introduction: When cancer spreads to the brain, patients and their families report a much reduced quality of life. Whole-brain radiation therapy (WBRT) and/or radiosurgery (RS) are mainstays of management for patients with metastatic brain cancer. Despite the ubiquity of this problem, little is known about the patients’ perspective regarding management-related complications. To assess the patients’ perspective regarding current therapeutic options, we retrospectively surveyed 200 consecutive patients who underwent radiosurgery with or without WBRT.

Methods and Materials: The survey consisted of 10 questions that sought information on quality of life, employment status, side effects (hair loss, fatigue, memory, concentration, mood, or employment), activity level, and satisfaction.

Results: We tabulated 104 responses (52%). WBRT was used in 69% (72 of 104); all patients had radiosurgery. After WBRT, the following were noted: hair loss (88%; total regrowth in 24%), excess fatigue (95%), problems with short-term memory (72%), long-term memory (33%), concentration (61%), and depression (54%). Sixty-three percent of patients who had WBRT thought they had side effects after treatment compared with 34% who had radiosurgery only (P <0.001). Only 5% of RS patients reported fatigue. Seventy-six percent and 56% of respondents considered RS or WBRT, respectively, a good treatment of them (P = 0.25). Only 26 patients (27%) were employed at the time of treatment and 16 remained employed (62%). Eighteen percent believed that WBRT delayed other cancer treatments.

Conclusions: Patients with brain metastases often report complications of their disease or its treatment. Side effects are most pronounced in those who received WBRT. Radiosurgery had fewer reported side effects and was believed by more patients or families to be effective. Further study of clinical outcomes and quality of life is important to guide our management of patients with these common brain tumors.

From the Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania.

Drs. Kondziolka and Lunsford serve as consultants to Elekta Instruments, Inc.

Reprints: Douglas Kondziolka, MD, MSc, FRCSC, Department of Neurological Surgery, UPMC Presbyterian, Suite B-400, 200 Lothrop St., Pittsburgh, PA 15213. E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.