Quality of Life in Patients with Brain Metastases

描述(由申请人提供)： 在美国，每年大约有20万人患上脑转移瘤。控制良好的全身性疾病的患者适合局部治疗，如手术切除或立体定向放射外科手术。随机试验表明，手术切除孤立性脑转移瘤可提高存活率和功能独立时间。回顾性队列研究表明，立体定向放射外科治疗可能提供类似的生存益处。在这些研究中，对生活质量(QOL)的评估是初步的。神经外科医生、肿瘤学家、患者和家属越来越关注生活质量对癌症患者的重要性。我们建议对一组接受手术切除或立体定向放射外科治疗的孤立性脑转移瘤患者进行前瞻性研究。我们将使用“基于偏好的”QOL测量技术(例如，Standard Gamble，EuroQol 5D)来测量QOL，使用Q-twist(一种结合癌症患者的生存期和QOL获得质量调整后的生存期的方法)的改进，结合基于偏好的QOL值，我们将计算两个治疗组的质量调整后的生存期。我们将探索质量调整后的生存与认知状态、抑郁、功能状态、疾病表现和治疗之间的关系。比较与手术切除和立体定向放射外科相关的质量调整后的存活率将为患者、家庭、肿瘤学家和神经外科医生考虑转移性脑肿瘤的治疗方案提供有价值的信息。虽然癌症研究的最终目标是消除和治愈癌症，但我们建议提供试点数据，最终导致I类证据支持脑转移患者的特定治疗方式，不仅基于生存，而且基于生活质量和质量调整后的生存。

DESCRIPTION (provided by applicant): Approximately 200,000 people in the US will develop a brain metastasis each year. Patients with well-controlled systemic disease are candidates for local therapy such as surgical resection or stereotactic radiosurgery. Randomized trials have shown that surgical resection of solitary brain metastases improves survival and duration of functional independence. Retrospective cohort studies suggest that stereotactic radiosurgery may offer a comparable survival benefit. The assessment of quality of life (QOL) in these studies has been rudimentary. Neurosurgeons, oncologists, patients, and families are increasingly focused on the importance of QOL for cancer patients. We propose a prospective study of a cohort of patients with solitary brain metastases receiving either surgical resection or stereotactic radiosurgery. We will use "preference-based" QOL measurement techniques (e.g., standard gamble, EuroQol 5D) to measure QOL using a modification of Q-TWiST (a method of combining survival and QOL in cancer patients to obtain quality-adjusted survival) that incorporates the preference-based QOL values, we will calculate the quality-adjusted survival in the two treatment groups. We will explore the relationships between quality-adjusted survival and cognitive status, depression, functional status, disease presentation, and treatment. Comparing quality-adjusted survival associated with surgical resection and stereotactic radiosurgery should provide valuable information for patients, families, oncologists, and neurosurgeons considering treatment alternatives for metastatic brain tumors. Although the ultimate goal of cancer research is to eliminate and cure cancer, we propose to provide pilot data eventually leading to Class I evidence supporting a specific treatment modality for patients with brain metastases based not alone on survival but quality of life and quality-adjusted survival.