Simultaneous in-field boost for patients with 1 to 4 brain metastasis/es treated with volumetric modulated arc therapy: a prospective study on quality-of-life.

Purpose: To assess treatment toxicity and patients’ survival /quality of life (QoL) after volumetric modulated arc therapy (VMAT) with simultaneous in-field boost (SIB) for cancer patients with 1 – 4 brain metastases (BM) treated with or without surgery. Methods and Materials: Between March and December 2010, 29 BM patients (total volume BM, < 40 cm3) aged < 80 years, KPS [greater than or equal to] 70, RPA < III were included in this prospective trial. Whole brain VMAT (30 Gy) and a SIB to the BM (40 Gy) was delivered in 10 fraction. Mean age was 62.1+/-8.5 years. Fifteen (51.7%) underwent surgery. KPS and MMSE were prospectively assessed. A self-assessed questionnaire was used to assess the QoL (EORTC QLQ-C30 with -BN20 module). Results: As of April 2011 and after a mean FU of 5.4+/-2.8 months, 14 (48.3%) patients died. The 6-month overall survival was 55.1%. Alopecia was only observed in 9 (31%) patients. In 3-month survivors, KPS was significantly (p=0.01) decreased. MMSE score remained however stable (p=0.33). Overall, QoL did decrease after VMAT. The mean QLQ-C30 global health status (p=0.72) and emotional functional (p=0.91) scores were decreased (low QoL). Physical (p=0.05) and role functioning score (p=0.01) were significantly worse and rapidly decreased during treatment. The majority of BN20 domains and single items worsened 3 months after VMAT except headaches (p=0.046) and bladder control (p=0.26) which improved. Conclusions: The delivery of 40 Gy in 10 fractions to 1 – 4 BM using VMAT was achieved with no significant toxicity. QoL, performance status, but not MMSE, was however compromised 3 months after treatment in this selected cohort of BM patients.