A European Organisation for Research and Treatment of Cancer Phase III Trial of Adjuvant Whole-Brain Radiotherapy Versus Observation in Patients With One to Three Brain Metastases From Solid Tumors After Surgical Resection or Radiosurgery: Quality-of-Life Results
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...Given the recent data confirming harm to cognition and QOL with WBRT (2,23,24), and the potential for a survival detriment when compromising QOL (25), we hypothesize that in patients 50 years of age that exposure to the adverse effects of WBRT without yielding a therapeutic gain with respect to distant brain relapse rates (no significant difference in distant brain failure was observed in these younger patients when treated with SRS alone vs SRS plus WBRT) (Table 2, and Fig....
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...With respect to quality of life (QOL), we have recently learned from the EORTC RCT comparing observation versus WBRT, after either SRS or surgery, that the addition of WBRT results in worse QOL outcomes (24)....
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...A standard method of interpretation was used for the HRQOL using the EORTC scores according to the minimal important difference approach.(16) Differences of at least 10 points (on a 0 to 100 scale) were classified as the minimum clinically meaningful change in an HRQOL parameter....
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...These data must be interpreted with caution, because the Mini-Mental State Examination has poor sensitivity in detecting neurocognitive problems in brain tumor patients(30); thus, the use of specific neurocognitive batteries of tests has now become mandatory in clinical trials.(31) Two recent randomized trials have reported early negative changes with respect to neurocognitive function after WBRT....
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