Health-related quality of life after Gamma Knife radiosurgery in patients with 1–10 brain metastases

Eline Verhaak*, Wietske C. M. Schimmel*, Karin Gehring, Wilco H. M. Emons, Patrick E. J. Hanssens, Margriet M. Sitskoorn

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

4 Citations (Scopus)
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Increasingly more patients with multiple (> 4) brain metastases (BM) are being treated with stereotactic radiosurgery (SRS). Preserving patients’ health-related quality of life (HRQoL) is an important treatment goal. The aim of this study was to assess (individual) changes in HRQoL in patients with 1–10 BM over time. 


A total of 92 patients were assessed before (n = 92) and at 3 (n = 66), 6 (n = 53), and 9 (n = 41) months after Gamma Knife radiosurgery (GKRS), using the Functional Assessment of Cancer Therapy-Brain (FACT-Br). The course of HRQoL was analyzed using linear mixed models. Clinical minimally important differences were used to evaluate individual changes. Results: At group level, patients’ physical well-being worsened, whereas emotional well-being improved over 9 months. Scores on other HRQoL subscales did not change significantly. Number (1–3 versus 4–10) and volume (small, medium, and large) of BM did not influence HRQoL over time, except for the subscale additional concerns; medium intracranial tumor volume was associated with less additional concerns. On the individual level as well, physical well-being declined while emotional well-being improved in most patients over 9 months after GKRS. At patient level, however, most patients had both declines as well as improvements in the different HRQoL aspects. 


Our results indicate that even in patients with up to 10 BM, both at group and individual subscale level, aspects of HRQoL remained stable over nine months after GKRS, except for an improvement in emotional well-being and a decline in physical well-being. Nevertheless, HRQoL scores varied considerably at the individual patient level. 

Trail registration number: Identifier: NCT02953756, November 3, 2016.

Original languageEnglish
Pages (from-to)1157-1167
JournalJournal of Cancer Research and Clinical Oncology
Issue number4
Publication statusPublished - 2021


  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Neoplasms/secondary
  • Female
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neoplasms/pathology
  • Prognosis
  • Prospective Studies
  • Quality of Life
  • Radiosurgery/mortality
  • Survival Rate


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