RESUMO
BACKGROUND: Optimal management for limited, non-resectable brain metastases is an evolving area in radiation oncology. Previous data show no difference in survival between stereotactic radiosurgery (SRS) and SRS plus whole-brain radiotherapy (WBRT). Neurocognitive toxicities, treatment duration and tumor recurrence differ and therefore patient values play an important role in decision making. We aim to elicit patient preferences and understand factors important in deciding which treatment to pursue. METHODS: Patients were recruited from 2 centers in North America. Eligibility criteria included ≤4 intracranial lesions and physician judgment that either treatment was appropriate. Those with prior treatment for brain metastases were excluded. A decision board presented the treatments and summarized evidence regarding disease control and toxicity. An option to either take an active or passive role was offered. If taking a passive role, treatment was left to the clinician. If an active role was taken, patients made a decision about whether to receive SRS alone, or in combination with WBRT. A debriefing questionnaire to rank important factors in decision making was then completed. Descriptive statistics summarized findings. RESULTS: A total of 23 patients were enrolled. The majority of patients were male (15/23; 65.2%), had primary lung cancer (15/23; 65.2%) and the mean age was 65.5 years. All patients took an active role in deciding their treatment. The majority of patients (21/23) chose to receive SRS alone. The highest ranked factors were quality of life (9.4/10), ability to maintain functional independence (9.3/10) and influence of treatment on survival (9.2/10). The least important factor was number of trips required to the cancer center (5.0/10). CONCLUSIONS: A patient centered approach to decision making in brain metastases is feasible. Most patients will take an active role in management if relevant information is presented in a clear, understandable manner. When informed, most patients prefer SRS alone rather than SRS + WBRT and identify quality of life, ability to maintain functional independence and influence of treatment on survival as highly important factors in making their decision.
