Quality of Life and Radiotherapy in Brain Metastases

Patients

Does radiotherapy improve the quality of life for patients with brain metastases?

MD PHECHUDI

BRAIN METASTASES

• What are brain metastases?• Who is likely to develop brain metastases?

• What are the symptoms?• How are brain metastases diagnosed and

evaluated?

What are brain metastases? • Cancer cells that spread to the brain from

primary tumours elsewhere in the body, for example the breast

http://www.itnonline.com/sites/default/files/imagecache/node_image/photo_article/Atlas-based_Brain_Critical_Structures_Segmentation_for_radiotherapy_planning.jpg

http://cancergrace.org/wp-content/uploads/2007/04/brain-mets-mri.jpg

Who is likely to develop brain metastases?

• The odds of developing brain metastases based on the primary type of cancer :

Lung

Melano

ma

Kidney

Breast

Colorec

tal

20%

7%10%

5%2%

EPIDEMIOLOGY

http://breakthroughs.cityofhope.org/wp-content/uploads/2012/01/brain1.jpg

How does it spread?

What are the typical symptoms?• Headaches • Seizures• Speech problems• Weakness• Impaired vision

• Pain or numbness• Paralysis • Nausea and

vomiting

One third of brain metastases patients experience at all

NO symptoms

Diagnosis And Evaluation

•  Brain metastases may be diagnosed and evaluated using one or more of several different types of procedures:

MRI ScanCT ScanPET ScanBiopsy

Diagnostic Modalities

www.dximaging.com/images/mri.ht53.jpg http://www.cerebromente.org.br/n01/pet/scanner.gif

MRI PET

Diagnostic Modalities

http://www.protons.com/common/images/virtual-tour/man-entering-ct-scan.jpg

CT

RADIOTHERAPY • What is radiotherapy?

• How is radiotherapy used to treat brain metastases?

• What are typical side effects?• Is there an improvement in symptoms after

treatment?• Does radiotherapy improve the quality of

life?

What is radiotherapy?• The treatment of disease (especially

cancer) by exposure to a radioactive substance

http://wordnetweb.princeton.edu/perl/webwn?s=radiotherapy

• Radical Radiotherapy: Aims to completely remove the disease

• Palliative Radiotherapy: Aims to relieve symptoms and improve quality of life

Radiotherapy Techniques

• WBRT delivers an even dose of radiation to the entire brain

• Can treat small, undetectable tumors that may be developing in different areas of the brain

• Often used to reduce risk of tumor recurrence post surgery

• Advantages:• Treat large and small tumors• Multiple tumors at the same time• Deep seated that are inaccessible to surgery

Whole Brain Radiation Treatment (WBRT)

Whole Brain Radiation Treatment (WBRT)

• When is it used?• Multiple tumors• People who are not eligible for surgery

• Side effects may include: • Nausea• Vomiting• Headache• Fever• memory loss• Fatigue

• Small risk of long-term radiation injury:• radiation necrosis • dementia.

Clinical Set-up

Whole Brain Radiation Treatment (WBRT)

Set-up can include a mask to ensure patient remains completely still

http://2.bp.blogspot.com/-JonU3bl-1lI/TxerJoH1qsI/AAAAAAAAAPM/-4K7hKdqyA/s1600/radiation1+%25282%2529.jpg

Whole Brain Radiation Treatment (WBRT)

Radiotherapy TechniquesStereotactic Radiosurgery

• More targeted form of radiation therapy—it isn’t surgery at all precise and focused

• Also called Gamma Knife®, XKnife™, Novalis®, and Cyberknife®

• Delivers a higher dose of radiation to a small tumor in a single treatment session

• The radiation beam is delivered to the tumor from many different angles using special computer planning

• A head frame keep the patient’s head completely still during the procedure.

http://radonc.ucsd.edu/patient-info/treatment-options/procedures/PublishingImages/Radiosurgery_for_Multiple_Brain_Metastasis.jpg

Stereotactic Radiosurgery

Radiotherapy TechniquesStereotactic Radiosurgery

• Advantages:• Precise - less likely to hurt healthy tissue

• When is it used?• To treat people with up to 3 brain tumors that is

not surgically accessible • Only treats tumors that can be detected on MRI or

CT scans

• Rare side effects include:• Swelling• Neurological problems and Necrosis

Video on Stereotactic Radiotherapy

Study of Brain Mets Patients

• What was the aim?• Who was included?

• What was the methodology?• What were the results?

• DOES RADIOTEHRAPY IMPROVE THE QUALITY OF LIFE FOR BRAIN

METASTASES PATIENTS?

Background

Aim• To assess if radiotherapy results

in an improved quality of life for patients with brain metastases

• 10-30% of patients with cancer develop brain metastases during the course of their illness

• Assessment of quality of life has been recognized as an important outcome

Who was involved?• 39 patients aged between 37-81 were

included in the study• Median age: 59.9 years old• All patients were receiving WBRT• 62% female; 38% male

Methodology • Patients were assessed through

questionnaires at baseline, 1 month, and 3 months after completion of WBRT

• Between baseline and 3months - large deterioration of cognitive functions after the treatment, appetite loss, drowsiness and hair loss

• General worsening of brain metastases related symptoms

• Small deterioration of global health status• 27 deaths occurred during the study• Median survival time:

Results

3 Months

What does this tell us?• Patients with a poor prognosis do not

benefit significantly from WBRT in terms of their quality of life (QoL)and symptoms

• Patients with a better prognosis are seen to have certain aspects of QoL improved after WBRT

• Low survival reports reflect poor outcome of patients

• More research needed to refine treatment for brain metastases patients

Conclusion

• Radiotherapy does not significantly improve the quality of life for brain metastases patients!

REFERENCES• http://www.braintumor.org/assets/docs/Understanding_Metastatic_Tumors.pdf

– Last Visited: 10 July 2013• http://www.irsa.org/metastatic_tumors.html

– Last Visited: 23 July 3012• http://www.medicinenet.com/brain_cancer/article.htm

– Last Visited: 23 July 2013• http://www.ncbi.nlm.nih.gov/pubmed/16215811

– Last Visited: 29 July 2013