Radiotherapy is a common treatment for brain metastases, but does it improve patients' quality of life? A study of 39 brain metastases patients assessed their quality of life before and after whole brain radiotherapy (WBRT) treatment. The results showed a deterioration in cognitive function, appetite, alertness and hair loss in patients after treatment. There was also a small decline in overall health and high mortality. The study concluded that WBRT does not significantly improve quality of life for brain metastases patients. More research is needed to refine treatment approaches.

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

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. http://breakthroughs.cityofhope.org/wp-content/uploads/2012/01/brain1.jpg
How does it
spread?

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

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

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. 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. 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. 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. Clinical Set-up
Whole Brain Radiation Treatment (WBRT)

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

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. Video on Stereotactic Radiotherapy

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

28. 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