Quality of life, predictions of survival, feeding options, and symptom control for patients with advanced disease

In this issue of Annals of Palliative Medicine, Chow et al. author an original report on baseline characteristics, symptoms, and quality of life following whole brain radiation therapy (WBRT) alone versus stereotactic radiosurgery (SRS) or neurosurgery with or without WBRT (1). WBRT has been a standard approach for the treatment of brain metastases for over 60 years (2), but there has been increasing interest in surgical resection (3) or SRS (4,5) to improve local control, reduce neurocognitive morbidity, and potentially even improve overall survival compared with WBRT alone. Current clinical decision on the use of WBRT alone versus local therapy with SRS or surgical resection with or without WBRT versus even palliative measures alone (6) is based on multiple features, including performance status, number of brain metastasis, primary tumor histology, extent of extracranial disease, and lesion resectability. The options to manage brain metastases have been the subject of numerous society guidelines and also a recent systematic review published in this journal (7). However, little has reported on how baseline quality of life characteristics have influences this treatment decision.