Therapy for recurrent high-grade gliomas: results of a prospective multicenter study on health-related quality of life

Item Type:	Article
Title:	Therapy for recurrent high-grade gliomas: results of a prospective multicenter study on health-related quality of life
Creators Name:	Stöckelmaier, L. and Renovanz, M. and König, J. and Nickel, K. and Hickmann, A.K. and Mayer-Steinacker, R. and Nadji-Ohl, M. and Ganslandt, O. and Bullinger, L. and Wirtz, C.R. and Coburger, J.
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, Recurrence Therapy, Recurrent Surgery, Re-radiation
Source:	World Neurosurgery
ISSN:	1878-8750
Publisher:	Elsevier
Volume:	102
Page Range:	383-399
Date:	June 2017
Official Publication:	https://doi.org/10.1016/j.wneu.2017.02.061
PubMed:	View item in PubMed

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