• Jacob A Miller, Rupesh Kotecha, Gene H Barnett, John H Suh, Lilyana Angelov, Erin S Murphy, Michael A Vogelbaum, Alireza Mohammadi, and Samuel T Chao.
• Cleveland Clinic Lerner College of Medi-cine, Cleveland Clinic, Cleveland, Ohio.
• Neurosurgery. 2017 Jul 1; 81 (1): 147-155.

BackgroundGiven the neurological morbidity and poor prognosis associated with brain metastases, it is critical to deliver appropriate therapy while remaining mindful of patient quality of life (QOL). For many patients, stereotactic radiosurgery (SRS) effectively controls intracranial disease, but QOL outcomes have not been characterized.ObjectiveTo determine the effect of number of brain metastases upon QOL preservation following SRS.MethodsThe EuroQol 5 Dimensions questionnaire (EQ-5D) and Patient Health Questionnaire 9 instruments were prospectively collected from a cohort of patients undergoing SRS for brain metastasis between 2008 and 2015. These instruments served as measures of overall QOL and depression. QOL deterioration exceeding the minimum clinically important difference was considered failure. Freedom from 12-month EQ-5D index failure was the primary outcome.ResultsOne hundred and twenty-two SRS treatments (67 patients, 421 lesions) were eligible for inclusion. Intracranial failure (local or distant) occurred following 61% of treatments. Among 421 lesions, 8% progressed locally. Median follow-up was 12 months.ConclusionsAmong patients with brain metastasis, QOL preservation must remain paramount as multimodality therapy continues to improve. In the present investigation, 12-month QOL preservation was 79%. However, patients with more than 3 brain metastases were at significantly greater risk for QOL decline.

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