Therapy for Recurrent High-Grade Gliomas: Results of a Prospective Multicenter Study on Health-Related Quality of Life

Linda Stöckelmaier; Mirjam Renovanz; Jochem König; Katrin Nickel; Anne-Katrin Hickmann; Regine Mayer-Steinacker; Minou Nadji-Ohl; Oliver Ganslandt; Lars Bullinger; Christian Rainer Wirtz; Jan Coburger

doi:10.1016/j.wneu.2017.02.061

Therapy for Recurrent High-Grade Gliomas: Results of a Prospective Multicenter Study on Health-Related Quality of Life

World Neurosurg. 2017 Jun:102:383-399. doi: 10.1016/j.wneu.2017.02.061. Epub 2017 Mar 11.

Affiliations

¹ Department of Neurosurgery, University of Ulm, Günzburg, Germany.
² Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University Mainz, Mainz, Germany.
³ Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes-Gutenberg-University Mainz, Mainz, Germany.
⁴ Center for Endoscopic and Minimally Invasive Neurosurgery, Clinic Hierslanden, Zürich, Switzerland.
⁵ Department of Internal Medicine III, Ulm University, Ulm, Germany.
⁶ Department of Neurosurgery, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany.
⁷ Department of Neurosurgery, University of Ulm, Günzburg, Germany. Electronic address: jan.coburger@uni-ulm.de.

PMID: 28288921
DOI: 10.1016/j.wneu.2017.02.061

Abstract

Objective: To assess the impact of therapy on patients' health-related quality of life (HRQoL) in recurrent high-grade glioma (HGG) in an unselected cohort.

Methods: In this prospective multicenter study, we analyzed European Organization for Research and Treatment of Cancer Quality of Life core questionnaire and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Brain Neoplasm module questionnaires of 92 patients within 1 year after diagnosis of tumor recurrence of a HGG and respective treatment. We evaluated the influence of re-radiation, second- and third-line chemotherapies, and number of recurrent surgeries on summary scores for functioning, symptoms, and total score as well as on subscores for functioning and neurologic symptoms using multivariate mixed models and descriptive statistics.

Results: After we adjusted for Karnofsky Performance Score and age, different recurrent therapies did not significantly impact HRQoL. Neither re-radiation nor recurrent surgery significantly influenced HRQoL (total score, P = 0.66; P = 0.64). Patients receiving second-line chemotherapy showed moderately better physical and role functioning as well as less motor dysfunction than patients receiving third-line chemotherapy. When we compared HRQoL after second-line chemotherapies, patients receiving intensified temozolomide dosages demonstrated a moderately better outcome for cognitive functioning and less communication deficits (P = 0.055) than patients treated with bevacizumab. Regarding number of recurrent surgeries, we found stable HRQoL scores until second recurrent surgery, whereas after third recurrent surgery HRQoL decreased.

Conclusions: Our results from an unselected cohort of recurrent HGGs show that the currently available treatment options have no negative impact on HRQoL. Thus, treatment decisions can be made individually, without fear of jeopardizing HRQoL for better survival. Only, the third recurrent surgery remains a very individual decision even in younger patients with high Karnofsky Performance Score.

Keywords: Chemotherapy; Health-related quality of life; High-grade glioma; KPS; Re-radiation; Recurrence therapy; Recurrent surgery.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Antineoplastic Agents / therapeutic use
Brain Neoplasms
Cohort Studies
Europe / epidemiology
Female
Glioma / psychology*
Glioma / therapy*
Humans
Karnofsky Performance Status
Male
Middle Aged
Neoplasm Recurrence, Local / psychology*
Neoplasm Recurrence, Local / therapy*
Prospective Studies
Quality of Life / psychology*
Radiotherapy, Adjuvant
Surveys and Questionnaires
Young Adult

Substances

Antineoplastic Agents