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Updated: May 6, 2026

Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy
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Patient-reported Symptoms Differ Between Patients With Brain Metastasis Starting Either Focal Stereotactic

Carsten Nieder1,2, Annette M Winther2, Silje K Johnsen2

  • 1Institute of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.

Cancer Diagnosis & Prognosis
|March 4, 2026
PubMed
Summary

Patients undergoing whole-brain radiotherapy (WBRT) for brain metastasis report higher symptom burden, including anxiety and fatigue, compared to those receiving stereotactic radiosurgery or fractionated radiotherapy (SRS/FSRT). This highlights potential differences in palliative care needs.

Keywords:
Palliative radiation therapymetastatic cancerprognosisquality of carestereotactic radiotherapy

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Area of Science:

  • Oncology
  • Palliative Care
  • Radiotherapy

Background:

  • Brain metastasis significantly impacts patient quality of life and symptom burden.
  • The Edmonton Symptom Assessment System (ESAS) is used to evaluate symptoms in these patients.
  • Limited data exist on ESAS scores for patients treated with radiotherapy techniques other than whole-brain radiotherapy (WBRT).

Purpose of the Study:

  • To compare ESAS symptom severity in patients with brain metastasis before different radiotherapy techniques.
  • Specifically, to compare symptom scores before WBRT versus stereotactic radiosurgery or fractionated radiotherapy (SRS/FSRT).

Main Methods:

  • Retrospective analysis of 102 patients with brain metastasis in Norway (2013-2024).
  • Patients were assessed using the ESAS.
  • Stratification based on radiotherapy approach: WBRT (with or without boost) versus SRS/FSRT.

Main Results:

  • Fatigue and overall wellbeing were the most prevalent symptoms across all patients.
  • Patients undergoing WBRT reported significantly higher scores for anxiety (p=0.03) and a trend towards higher scores for fatigue and overall wellbeing compared to SRS/FSRT.
  • The total symptom score sum was significantly higher for the WBRT cohort (mean 31.7) than the SRS/FSRT cohort (mean 18.5, p=0.03).

Conclusions:

  • Clinicians using ESAS for patients starting radiotherapy should recognize that WBRT may be associated with a greater symptom burden.
  • Patients receiving WBRT may require more intensive palliative care services compared to those treated with SRS/FSRT.
  • Differences in symptom severity, particularly anxiety and fatigue, are not explained by metastasis number or diagnostic setting.