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brain metastasis cancer

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

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brain metastasis cancer

  1. 1. Quality of Life and Radiotherapy in Brain Metastases Patients Does radiotherapy improve the quality of life for patients with brain metastases? MD PHECHUDI
  2. 2. BRAIN METASTASES • What are brain metastases? • Who is likely to develop brain metastases? • What are the symptoms? • How are brain metastases diagnosed and evaluated?
  3. 3. 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
  4. 4. http://cancergrace.org/wp-content/uploads/2007/04/brain-mets- mri.jpg
  5. 5. Who is likely to develop brain metastases? • The odds of developing brain metastases based on the primary type of cancer : 20% 7% 10% 5% 2% EPIDEMIOLOGY
  6. 6. http://breakthroughs.cityofhope.org/wp-content/uploads/2012/01/brain1.jpg How does it spread?
  7. 7. 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
  8. 8. Diagnosis And Evaluation • Brain metastases may be diagnosed and evaluated using one or more of several different types of procedures: MRI Scan CT Scan PET Scan Biopsy
  9. 9. Diagnostic Modalities www.dximaging.com/images/mri.ht53.jpg http://www.cerebromente.org.br/n01/pet/scanner.gif MRI PET
  10. 10. Diagnostic Modalities http://www.protons.com/common/images/virtual-tour/man-entering-ct-scan.jpg CT
  11. 11. 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?
  12. 12. 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
  13. 13. 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)
  14. 14. 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.
  15. 15. Clinical Set-up Whole Brain Radiation Treatment (WBRT)
  16. 16. 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)
  17. 17. Radiotherapy Techniques Stereotactic 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.
  18. 18. http://radonc.ucsd.edu/patient-info/treatment- options/procedures/PublishingImages/Radiosurgery_for_Multiple_Brain_Metastasis.jpg Stereotactic Radiosurgery
  19. 19. Radiotherapy Techniques Stereotactic 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
  20. 20. Video on Stereotactic Radiotherapy
  21. 21. 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?
  22. 22. 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
  23. 23. 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
  24. 24. • 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
  25. 25. 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
  26. 26. Conclusion • Radiotherapy does not significantly improve the quality of life for brain metastases patients!
  27. 27. 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

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