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Gómez Vecchio T, Rydén I, Ozanne A, Blomstrand M, Carstam L, Smits A, Jakola AS. Global health status and fatigue score in isocitrate dehydrogenase-mutant diffuse glioma grades 2 and 3: A longitudinal population-based study from surgery to 12-month follow-up. Neurooncol Pract 2024; 11:347-357. [PMID: 38737607 PMCID: PMC11085849 DOI: 10.1093/nop/npae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background At the group level, health-related quality of life (HRQoL) in patients with IDH-mutant diffuse glioma grades 2 and 3 seems to remain stable over time. However, clinical experience indicates that there are patients with unfavorable outcomes on key HRQoL subdomains. The aim of this longitudinal population-based study, following patients over a period of 12 months from surgery, was to describe individual-level data on global health status and fatigue score and explore possible predictors of deterioration. Methods All patients undergoing surgery for presumed glioma grades 2 or 3 at the Sahlgrenska University Hospital during 2017-2022, were screened for the study. Patients were invited to complete the European Organization of Research and Treatment of Cancer core questionnaires and brain module at baseline, 3 and 12 months postoperatively. Data is reported with respect to minimal clinical important difference (MCID). Results We included 51 patients with IDH-mutant diffuse glioma grades 2 or 3. There was no difference in group-level data of either global health status or fatigue score from baseline to the 12-month follow-up (P-value > .05). Unfavorable individual changes (beyond MCID) in global health status and fatigue score were observed in 12 and in 17 patients, respectively (23.5% and 33.3%). A lower proportion of proton radiotherapy was found in patients with unfavorable changes in fatigue (10/15, 66.7%) compared to all other patients undergoing radiotherapy (22/23, 95.7%, P-value .03). Conclusions Deterioration beyond MCID was seen in approximately one-third of patients. Changes in global health status could not be predicted, but changes in fatigue may be influenced by tumor-targeted and symptomatic treatment.
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Affiliation(s)
- Tomás Gómez Vecchio
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Isabelle Rydén
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anneli Ozanne
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Malin Blomstrand
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Louise Carstam
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anja Smits
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Asgeir Store Jakola
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Nichols NM, Ezzat B, Waters AC, Panov F, Yong RL, Germano IM. What is the cognitive footprint of insular glioma? Front Hum Neurosci 2024; 18:1382380. [PMID: 38859993 PMCID: PMC11163043 DOI: 10.3389/fnhum.2024.1382380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/29/2024] [Indexed: 06/12/2024] Open
Abstract
Cognitive impairment has a profound deleterious impact on long-term outcomes of glioma surgery. The human insula, a deep cortical structure covered by the operculum, plays a role in a wide range of cognitive functions including interceptive thoughts and salience processing. Both low-grade (LGG) and high-grade gliomas (HGG) involve the insula, representing up to 25% of LGG and 10% of HGG. Surgical series from the past 30 years support the role of primary cytoreductive surgery for insular glioma patients; however, reported cognitive outcomes are often limited to speech and language function. The breath of recent neuroscience literature demonstrates that the insula plays a broader role in cognition including interoceptive thoughts and salience processing. This article summarizes the vast functional role of the healthy human insula highlighting how this knowledge can be leveraged to improve the care of patients with insular gliomas.
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Affiliation(s)
- Noah M Nichols
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, United States
| | - Bahie Ezzat
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, United States
- School of Medicine, Mount Sinai School of Medicine, New York, NY, United States
| | - Allison C Waters
- Department of Neuroscience, Mount Sinai School of Medicine, New York, NY, United States
| | - Fedor Panov
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, United States
| | - Raymund L Yong
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, United States
| | - Isabelle M Germano
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, United States
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Darlix A, Monnier M, Castan F, Coutant L, Fabbro M, Denis-Chammas È, Carrière M, Menjot-de-Champfleur N, Rigau V, Duffau H, Guerdoux E. Longitudinal assessment of quality of life, neurocognition, and psychopathology in patients with low-grade glioma on first-line temozolomide: A feasibility study. Neurooncol Adv 2024; 6:vdae084. [PMID: 38946878 PMCID: PMC11212068 DOI: 10.1093/noajnl/vdae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background The treatment timing and choice after neurosurgical resection in patients with newly diagnosed diffuse low-grade glioma (DLGG) remain controversial. Indeed, the effect of such treatments must be balanced with the possible side effects. This study evaluated the feasibility of longitudinal exhaustive quality of life (QoL) and neuropsychological assessments in patients with DLGG receiving first-line temozolomide. Methods QoL, neurocognition, and psychological disorders were assessed prospectively until disease progression, using testing, clinician-reported, and self-reported questionnaires. The primary endpoint was the participation and adherence to this complete assessment at Baseline (before temozolomide initiation), months 6 and 12 of treatment, and month 6 post-treatment. The QoL and neuropsychological changes over time also were described. Results Twenty-six of the twenty-nine eligible patients were enrolled (participation rate: 89.7%, 95% CI: 72.6-97.8). The adherence rate was 95.7% (95% CI: 78.1-99.9; n = 23 because 3 patients progressed in the first 12 months of treatment). Up to month 6 post-treatment, QoL and fatigue remained stable (EORTC QLQC30 and BN20, MFI-20); some specific symptoms were transitory. Both subjective (FACT-Cog) and objective (Z-scores of neurocognitive tests) neurocognitive outcomes remained stable or tended to improve. The percentage of patients with severe depression (BDI-II), anxiety (STAI-Y), or anger (STAXI-II) was stable over time. Conclusions This prospective study demonstrated the feasibility of an exhaustive and longitudinal evaluation of QoL, neurocognition, and psychological disorders, with high acceptability by patients with DLGG undergoing chemotherapy. First-line temozolomide seems to have limited short-term effects on QoL and neurocognition. These findings must be confirmed in the long term and in a larger cohort.
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Affiliation(s)
- Amélie Darlix
- Institut de Génomique Fonctionnelle, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Medical Oncology, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Maëva Monnier
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Florence Castan
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Louise Coutant
- Department of Supportive Care, Psycho-Oncology Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Michel Fabbro
- Department of Medical Oncology, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Ève Denis-Chammas
- Department of Neuroradiology, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Mathilde Carrière
- Department of Neuroradiology, University of Montpellier, CHU Montpellier, Montpellier, France
| | | | - Valérie Rigau
- Institut de Génomique Fonctionnelle, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Pathology, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Hugues Duffau
- Institut de Génomique Fonctionnelle, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Neurosurgery, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Estelle Guerdoux
- Department of Supportive Care, Psycho-Oncology Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health (IDESP), INSERM, Montpellier Cancer Institute (ICM), University of Montpellier, France
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Toader C, Eva L, Costea D, Corlatescu AD, Covache-Busuioc RA, Bratu BG, Glavan LA, Costin HP, Popa AA, Ciurea AV. Low-Grade Gliomas: Histological Subtypes, Molecular Mechanisms, and Treatment Strategies. Brain Sci 2023; 13:1700. [PMID: 38137148 PMCID: PMC10741942 DOI: 10.3390/brainsci13121700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Low-Grade Gliomas (LGGs) represent a diverse group of brain tumors originating from glial cells, characterized by their unique histopathological and molecular features. This article offers a comprehensive exploration of LGGs, shedding light on their subtypes, histological and molecular aspects. By delving into the World Health Organization's grading system, 5th edition, various specificities were added due to an in-depth understanding of emerging laboratory techniques, especially genomic analysis. Moreover, treatment modalities are extensively discussed. The degree of surgical resection should always be considered according to postoperative quality of life and cognitive status. Adjuvant therapies focused on chemotherapy and radiotherapy depend on tumor grading and invasiveness. In the current literature, emerging targeted molecular therapies are well discussed due to their succinctly therapeutic effect; in our article, those therapies are summarized based on posttreatment results and possible adverse effects. This review serves as a valuable resource for clinicians, researchers, and medical professionals aiming to deepen their knowledge on LGGs and enhance patient care.
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Affiliation(s)
- Corneliu Toader
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania
| | - Lucian Eva
- Department of Neurosurgery, Dunarea de Jos University, 800010 Galati, Romania
- Department of Neurosurgery, Clinical Emergency Hospital “Prof. Dr. Nicolae Oblu”, 700309 Iasi, Romania
| | - Daniel Costea
- Department of Neurosurgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Antonio Daniel Corlatescu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
| | - Luca Andrei Glavan
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
| | - Horia Petre Costin
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
| | - Andrei Adrian Popa
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
- Neurosurgery Department, Sanador Clinical Hospital, 010991 Bucharest, Romania
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The need to consider return to work as a main outcome in patients undergoing surgery for diffuse low-grade glioma: a systematic review. Acta Neurochir (Wien) 2022; 164:2789-2809. [PMID: 35945356 DOI: 10.1007/s00701-022-05339-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/02/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE For a long time, return to work (RTW) has been neglected in patients harboring a diffuse low-grade glioma (LGG). However, a majority of LGG patients worked at time of diagnosis. Moreover, these patients now live longer given current treatment paradigms, especially thanks to early maximal surgery. METHODS We systematically searched available medical databases for studies that reported data on RTW in patients who underwent resection for LGG. RESULTS A total of 30 studies were selected: 19 considered RTW (especially rate and timing) as an outcome and 11 used scales of health-related quality of life (HRQoL) which included work-related aspects. Series that considered RTW as a main endpoint were composed of 1014 patients, with postoperative RTW rates ranging from 31 to 97.1% (mean 73.1%). Timing to RTW ranged from 15 days to 22 months (mean 6.3 months). Factors related to an increased proportion of RTW were: younger age, better neurologic status, having a white-collar occupation, working pre-operatively, being the sole breadwinner, the use of awake surgery, and greater extent of resection. Female sex, older age, poor neurologic status, pre-operative history of work absences, slow lexical access speed, and postoperative seizures were negatively related to RTW. No studies that used HRQoL scales directly investigated RTW rate or timing. CONCLUSIONS RTW was scarcely analyzed in LGG patients who underwent resection. However, because they are usually young, with no or only mild functional deficits and have a longer life expectancy, postoperative RTW should be assessed more systematically and accurately as a main outcome. As majority (61.5-100%) of LGG patients were working at time of surgery, the responsibility of neurosurgeons is to bring these patients back to their previous activities according to his/her wishes. RTW might also be included as a critical endpoint for future prospective studies and randomized control trials on LGGs.
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Boele FW, den Otter PWM, Reijneveld JC, de Witt Hamer PC, van Thuijl HF, Lorenz LMC, Wesseling P, Lagerwaard FJ, Taphoorn MJB, Kouwenhoven MCM, Snijders TJ, Douw L, Klein M. Long-term wellbeing and neurocognitive functioning of diffuse low-grade glioma patients and their caregivers: A longitudinal study spanning two decades. Neuro Oncol 2022; 25:351-364. [PMID: 35908832 PMCID: PMC9925694 DOI: 10.1093/neuonc/noac185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While patients with diffuse low-grade glioma (LGG) often survive for years, there is a risk of tumor progression which may impact patients' long-term health-related quality of life (HRQOL) and neurocognitive functioning (NCF). We present a follow-up of LGG patients and their informal caregivers (T3) who took part in our previous HRQOL investigations (T1, M = 7 and T2 M = 13 years after diagnosis). METHODS Participants completed HRQOL (short form-36 health survey [SF-36]; EORTC-BN20), fatigue (Checklist Individual Strength [CIS]), and depression (Center for Epidemiological Studies-Depression [CES-D]) questionnaires and underwent NCF assessments. T3 scores were compared with matched controls. Changes over time (T1-T2-T3) on group and participant level were assessed. Where available, histology of the initial tumor was revised and immunohistochemical staining for IDH1 R132H mutant protein was performed. RESULTS Thirty patients and nineteen caregivers participated. Of N = 11 with tissue available, 3 patients had confirmed diffuse LGG. At T3, patients (M = 26 years after diagnosis) had HRQOL and NCF similar to, or better than controls, yet 23.3% and 53.3% scored above the cut-off for depression (≥16 CES-D) and fatigue (≥35 CIS), respectively. Caregivers' HRQOL was similar to controls but reported high rates of fatigue (63.2%). Over time, patients' mental health improved (P < .05). Minimal detectable change in HRQOL over time was observed in individual patients (30% improvement; 23.3% decline; 20% both improvement and decline) with 23.3% remaining stable. NCF remained stable or improved in 82.8% of patients. CONCLUSIONS While HRQOL and NCF do not appear greatly impacted during long-term survivorship in LGG, depressive symptoms and fatigue are persistent.
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Affiliation(s)
- Florien W Boele
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, UK,Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Patricia W M den Otter
- Department of Medical Psychology, Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jaap C Reijneveld
- Department of Neurology, SEIN, Heemstede, the Netherlands,Department of Neurology, Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Philip C de Witt Hamer
- Department of Neurosurgery, Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hinke F van Thuijl
- Department of Neurology, SEIN, Heemstede, the Netherlands,Department of Neurology, Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Linda M C Lorenz
- Department of Medical Psychology, Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pieter Wesseling
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Laboratory for Childhood Cancer Pathology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Frank J Lagerwaard
- Department of Radiation Oncology, Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Mathilde C M Kouwenhoven
- Department of Neurology, Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Tom J Snijders
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Linda Douw
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martin Klein
- Corresponding Author: Martin Klein, PhD, Department of Medical Psychology, Amsterdam UMC, location Vrije Universiteit Amsterdam, De Boelelaan 1118, PK 1Y 176, 1081 HZ Amsterdam, the Netherlands ()
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Patient-Reported Quality of Life in Grade 2 and 3 Gliomas after Surgery, Can We Do More? Clin Neurol Neurosurg 2022; 214:107175. [DOI: 10.1016/j.clineuro.2022.107175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/01/2022] [Accepted: 02/10/2022] [Indexed: 12/11/2022]
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Weyer-Jamora C, Brie MS, Luks TL, Smith EM, Hervey-Jumper SL, Taylor JW. Postacute Cognitive Rehabilitation for Adult Brain Tumor Patients. Neurosurgery 2021; 89:945-953. [PMID: 33586764 PMCID: PMC8600173 DOI: 10.1093/neuros/nyaa552] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/04/2020] [Indexed: 11/14/2022] Open
Abstract
Intrinsic brain tumors often occur within functional neural networks, leading to neurological impairment and disability of varying degrees. Advances in our understanding of tumor-network integration, human cognition and language processing, and multiparametric imaging, combined with refined intraoperative tumor resection techniques, have enhanced surgical management of intrinsic brain tumors within eloquent areas. However, cognitive symptoms impacting health-related quality of life, particularly processing speed, attention, concentration, working memory, and executive function, often persist after the postoperative recovery period and treatment. Multidisciplinary cognitive rehabilitation is the standard of care for addressing cognitive impairments in many neurological diseases. There is promising research to support the use of cognitive rehabilitation in adult brain tumor patients. In this review, we summarize the history and usefulness of postacute cognitive rehabilitation for adult brain tumor patients.
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Affiliation(s)
- Christina Weyer-Jamora
- Department of Neurological Surgery, University of CaliforniaSan Francisco, San Francisco, California
- Department of Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Melissa S Brie
- Department of Neurological Surgery, University of CaliforniaSan Francisco, San Francisco, California
- Department of Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Tracy L Luks
- Department of Radiology and Biomedical Imaging, University of CaliforniaSan Francisco, San Francisco, California
| | - Ellen M Smith
- Department of Neurological Surgery, University of CaliforniaSan Francisco, San Francisco, California
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of CaliforniaSan Francisco, San Francisco, California
| | - Jennie W Taylor
- Department of Neurological Surgery, University of CaliforniaSan Francisco, San Francisco, California
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
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Frances SM, Velikova G, Klein M, Short SC, Murray L, Wright JM, Boele F. Long-term impact of adult WHO grade II or III gliomas on health-related quality of life: A systematic review. Neurooncol Pract 2021; 9:3-17. [PMID: 35087674 PMCID: PMC8789291 DOI: 10.1093/nop/npab062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Glioma diagnosis can be devastating and result in a range of symptoms. Relatively little is known about the long-term health-related quality of life (HRQOL) challenges faced by these patients. Establishing the impact of diagnosis on HRQOL could help positively tailor clinical decision making regarding patient support and treatment. The aim of this review is to identify the long-term HRQOL issues reported at least 2 years following diagnosis of WHO grade II/III glioma. Method Systematic literature searches were carried out using Medline, EMBASE, CINAHL, PsycINFO, and Web of Science Core Collection. Searches were designed to identify patient self-reports on HRQOL aspects defined as physical, mental, or social issues. Quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). Narrative synthesis was used to collate findings. Results The search returned 8923 articles. Two hundred seventy-eight titles remained after title and abstract screening, with 21 full-text articles included in the final analysis. The majority of studies used quantitative methods, with 3 articles reporting mixed methodology. Negative emotional/psychological/cognitive changes were the most commonly reported. Physical complaints included fatigue, seizures, and restricted daily activity. Social challenges included strained social relationships and financial problems. Patient coping strategies were suggested to influence patient’s survival quality. Conclusion The consequences of a glioma diagnosis and treatment can have substantial implications for patients’ long-term HRQOL and daily functioning. Findings from this review lay the groundwork for efforts to improve patient HRQOL in long-term survivorship.
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Affiliation(s)
- Sé Maria Frances
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, UK
| | - Galina Velikova
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, UK
- Leeds Institute of Molecular Research, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Martin Klein
- Department of Medical Psychology, Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Susan C Short
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Leeds Institute of Molecular Research, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Louise Murray
- Leeds Institute of Molecular Research, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Judy M Wright
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Florien Boele
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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10
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Noll K, King AL, Dirven L, Armstrong TS, Taphoorn MJB, Wefel JS. Neurocognition and Health-Related Quality of Life Among Patients with Brain Tumors. Hematol Oncol Clin North Am 2021; 36:269-282. [PMID: 34711455 DOI: 10.1016/j.hoc.2021.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Patients with brain tumors experience great symptom burden across various domains of functioning, with associated decreases in health-related quality of life and general well-being. Impaired neurocognitive functioning is among the primary concerns of these patients. Unfortunately, most patients will experience such impairment at some point in the disease. However, impaired neurocognitive functioning, symptom burden, and well-being vary according numerous patient-, tumor-, and treatment-related factors. Recent work has furthered our understanding of these contributors to patient functioning and health-related quality of life and also points to various potential targets for prevention and intervention strategies, though more efficacious treatments remain needed.
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Affiliation(s)
- Kyle Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030, USA
| | - Amanda L King
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Road, Building 82, Room 214, Bethesda, MD 20892, USA
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands; Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, the Netherlands
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 82, Room 201, Bethesda, MD 20892, USA
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands; Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, the Netherlands
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030, USA; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030, USA.
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11
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Optimal Combinations of Chemotherapy and Radiotherapy in Low-Grade Gliomas: A Mathematical Approach. J Pers Med 2021; 11:jpm11101036. [PMID: 34683177 PMCID: PMC8537400 DOI: 10.3390/jpm11101036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 12/16/2022] Open
Abstract
Low-grade gliomas (LGGs) are brain tumors characterized by their slow growth and infiltrative nature. Treatment options for these tumors are surgery, radiation therapy and chemotherapy. The optimal use of radiation therapy and chemotherapy is still under study. In this paper, we construct a mathematical model of LGG response to combinations of chemotherapy, specifically to the alkylating agent temozolomide and radiation therapy. Patient-specific parameters were obtained from longitudinal imaging data of the response of real LGG patients. Computer simulations showed that concurrent cycles of radiation therapy and temozolomide could provide the best therapeutic efficacy in-silico for the patients included in the study. The patient cohort was extended computationally to a set of 3000 virtual patients. This virtual cohort was subject to an in-silico trial in which matching the doses of radiotherapy to those of temozolomide in the first five days of each cycle improved overall survival over concomitant radio-chemotherapy according to RTOG 0424. Thus, the proposed treatment schedule could be investigated in a clinical setting to improve combination treatments in LGGs with substantial survival benefits.
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12
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Duffau H. Updated perspectives on awake neurosurgery with cognitive and emotional assessment for patients with low-grade gliomas. Expert Rev Neurother 2021; 21:463-473. [PMID: 33724148 DOI: 10.1080/14737175.2021.1901583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Thanks to early extensive surgical resection combined with medical oncological therapies, life expectancy dramatically increased in low-grade glioma (LGG), with an overall survival currently over 15 years. Therefore, patients should be able to maintain valuable family and socio-professional activities.Areas covered: For many decades, cognitive and emotional aspects were neglected by surgical and medical neurooncologists. The goal of surgery was to avoid hemiplegia and/or aphasia, with no considerations regarding behavior. However, because LGG patients live longer, they must be cognitively and affectively able to make long-term projects. Preservation of higher-order functions should be considered systematically in LGG surgery by means of awake cognitive/emotional mapping and monitoring.Expert opinion: The aim is to incorporate recent advances in neurosciences, which proposed revisited models of cerebral processing relying on a meta-network perspective, into the pre-, intra- and postoperative procedure. In this connectomal approach, brain functions result from complex interactions within and between neural networks. This improved understanding of a constant instability of the neural system allows a better cognitive/emotional assessment before and after each treatment over years, in order to preserve personality and adaptive behavior for each LGG patient, based on his/her own definition of quality of life. It is time to create oncological neurosciences.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery Gui De Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1191 Laboratory Team "Brain Plasticity, Stem Cells and Low-Grade Gliomas", Institute of Functional Genomic, University of Montpellier, Montpellier, France
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13
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Wang J, Zheng X, Zhang J, Xue H, Wang L, Jing R, Chen S, Che F, Heng X, Li G, Xue F. An MRI-based radiomics signature as a pretreatment noninvasive predictor of overall survival and chemotherapeutic benefits in lower-grade gliomas. Eur Radiol 2021; 31:1785-1794. [PMID: 33409797 DOI: 10.1007/s00330-020-07581-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/13/2020] [Accepted: 12/01/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The aim of this study was to develop and validate a radiomics signature for predicting survival and chemotherapeutic benefits of patients with lower-grade gliomas (LGG). METHODS Radiomics features were extracted from precontrast axial fluid-attenuated inversion recovery (FLAIR) and contrast-enhanced axial T-1 weighted (CE-T1-w) sequence. Lasso Cox regression model was used for feature selection and radiomics signature building. The radiomics signature was developed in a primary cohort that consisted of 149 LGG patients and was then validated on an entirely new validation cohort that contained 66 LGG patients. A radiomics nomogram for the prediction of OS was established by adding the radiomics to clinicopathologic nomogram which developed with clinical data. RESULTS A radiomics signature derived from joint CE-T1-w and FLAIR images showed better prognostic performance (C-index, 0.798) than signatures derived from CE-T1-w (C-index, 0.744) or FLAIR (C-index, 0.736) sequences alone. Multivariable Cox regression revealed that the radiomics signature was an independent prognostic factor. One radiomics nomogram integrated the radiomics signature from joint CE-T1-w and FLAIR sequences with the clinicopathologic nomogram outperformed the clinicopathologic nomogram based on clinicopathologic data alone in predicting OS of LGG (C-index, 0.821 vs. 0.692; p < 0.001). Further analysis revealed that patients with higher radiomics signature were prone to benefit from chemotherapy. CONCLUSIONS The radiomics signature was independent with clinicopathologic data and was a noninvasive pretreatment predictor for LGG patients' survival. Moreover, it could predict which patients with LGG benefit from chemotherapy. KEY POINTS • A radiomics signature derived from joint CE-T1-w and FLAIR sequences showed better prognostic performance than signatures derived from either single imaging modality. • The radiomics signature is an independent prognostic factor and outperformed clinicopathologic features in predicting overall survival of LGG patients. • The radiomics signature could help preoperatively identify LGG patients who may benefit from chemotherapy.
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Affiliation(s)
- Jingtao Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China
- Institute for Medical Dataology, Shandong University, 12550 Erhuandong Road, Jinan, 250002, Shandong, China
| | - Xuejun Zheng
- Department of Radiology, The Linyi People's Hospital, Shandong University, 27 Jiefang Road, Linyi, 276000, Shandong, China
| | - Jinling Zhang
- Cancer Center & The Research Center Of Function Image on Brain Tumor, The Linyi People's Hospital, Shandong University, 27 Jiefang Road, Linyi, 276000, Shandong, China
| | - Hao Xue
- Department of Neurosurgery, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Lijie Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China
- Institute for Medical Dataology, Shandong University, 12550 Erhuandong Road, Jinan, 250002, Shandong, China
| | - Rui Jing
- Department of Radiology, Second Hospital of Shandong University, 247 Beiyuan Road, Jinan, 250000, Shandong, China
| | - Shuo Chen
- Division of Biostatistics and Bioinformatics, Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, 55 Wade Avenue, Baltimore, MD, 20742, USA
| | - Fengyuan Che
- Neurology Department & The Research Center of Function Image on Brain Tumor, The Linyi People's Hospital, Shandong University, 27 Jiefang Road, Linyi, 276000, Shandong, China
| | - Xueyuan Heng
- Neurology Department & The Research Center of Function Image on Brain Tumor, The Linyi People's Hospital, Shandong University, 27 Jiefang Road, Linyi, 276000, Shandong, China
| | - Gang Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China.
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China.
- Institute for Medical Dataology, Shandong University, 12550 Erhuandong Road, Jinan, 250002, Shandong, China.
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14
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Morshed RA, Young JS, Kroliczek AA, Berger MS, Brang D, Hervey-Jumper SL. A Neurosurgeon's Guide to Cognitive Dysfunction in Adult Glioma. Neurosurgery 2020; 89:1-10. [PMID: 33289504 DOI: 10.1093/neuros/nyaa400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/02/2020] [Indexed: 11/13/2022] Open
Abstract
Cognitive decline is common among patients with low- and high-grade glioma and can significantly impact quality of life. Although cognitive outcomes have been studied after therapeutic interventions such as surgery and radiation, it is important to understand the impact of the disease process itself prior to any interventions. Neurocognitive domains of interest in this disease context include intellectual function and premorbid ability, executive function, learning and memory, attention, language function, processing speed, visuospatial function, motor function, and emotional function. Here, we review oncologic factors associated with more neurocognitive impairment, key neurocognitive tasks relevant to glioma patient assessment, as well as the relevance of the human neural connectome in understanding cognitive dysfunction in glioma patients. A contextual understanding of glioma-functional network disruption and its impact on cognition is critical in the surgical management of eloquent area tumors.
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Affiliation(s)
- Ramin A Morshed
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Jacob S Young
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Arlena A Kroliczek
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - David Brang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
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15
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Darlix A, Rigau V, Duffau H. Neoformazioni intracraniche: gliomi di grado II. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)44227-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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Pérez-García VM, Ayala-Hernández LE, Belmonte-Beitia J, Schucht P, Murek M, Raabe A, Sepúlveda J. Computational design of improved standardized chemotherapy protocols for grade II oligodendrogliomas. PLoS Comput Biol 2019; 15:e1006778. [PMID: 31306418 PMCID: PMC6629055 DOI: 10.1371/journal.pcbi.1006778] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/24/2019] [Indexed: 11/18/2022] Open
Abstract
Here we put forward a mathematical model describing the response of low-grade (WHO grade II) oligodendrogliomas (LGO) to temozolomide (TMZ). The model describes the longitudinal volumetric dynamics of tumor response to TMZ of a cohort of 11 LGO patients treated with TMZ. After finding patient-specific parameters, different therapeutic strategies were tried computationally on the 'in-silico twins' of those patients. Chemotherapy schedules with larger-than-standard rest periods between consecutive cycles had either the same or better long-term efficacy than the standard 28-day cycles. The results were confirmed in a large trial of 2000 virtual patients. These long-cycle schemes would also have reduced toxicity and defer the appearance of resistances. On the basis of those results, a combination scheme consisting of five induction TMZ cycles given monthly plus 12 maintenance cycles given every three months was found to provide substantial survival benefits for the in-silico twins of the 11 LGO patients (median 5.69 years, range: 0.67 to 68.45 years) and in a large virtual trial including 2000 patients. We used 220 sets of experiments in-silico to show that a clinical trial incorporating 100 patients per arm (standard intensive treatment versus 5 + 12 scheme) could demonstrate the superiority of the novel scheme after a follow-up period of 10 years. Thus, the proposed treatment plan could be the basis for a standardized TMZ treatment for LGO patients with survival benefits.
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Affiliation(s)
- Víctor M. Pérez-García
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), Universidad de Castilla-La Mancha, Avda. Camilo José Cela, 3, 13071 Ciudad Real, Spain
| | - Luis E. Ayala-Hernández
- Departamento de Ciencias Exactas y Tecnología Centro Universitario de los Lagos, Universidad de Guadalajara, Lagos de Moreno, Mexico
| | - Juan Belmonte-Beitia
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), Universidad de Castilla-La Mancha, Avda. Camilo José Cela, 3, 13071 Ciudad Real, Spain
| | - Philippe Schucht
- Universitätsklinik für Neurochirurgie, Bern University Hospital, CH-3010 Bern, Switzerland
| | - Michael Murek
- Universitätsklinik für Neurochirurgie, Bern University Hospital, CH-3010 Bern, Switzerland
| | - Andreas Raabe
- Universitätsklinik für Neurochirurgie, Bern University Hospital, CH-3010 Bern, Switzerland
| | - Juan Sepúlveda
- Oncology Unit, Hospital 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
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17
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Darlix A, Mandonnet E, Freyschlag CF, Pinggera D, Forster MT, Voss M, Steinbach J, Loughrey C, Goodden J, Banna G, Di Blasi C, Foroglou N, Hottinger AF, Baron MH, Pallud J, Duffau H, Rutten GJ, Almairac F, Fontaine D, Taillandier L, Pessanha Viegas C, Albuquerque L, von Campe G, Urbanic-Purkart T, Blonski M. Chemotherapy and diffuse low-grade gliomas: a survey within the European Low-Grade Glioma Network. Neurooncol Pract 2019; 6:264-273. [PMID: 31386080 PMCID: PMC6660823 DOI: 10.1093/nop/npy051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Diffuse low-grade gliomas (DLGGs) are rare and incurable tumors. Whereas maximal safe, functional-based surgical resection is the first-line treatment, the timing and choice of further treatments (chemotherapy, radiation therapy, or combined treatments) remain controversial. METHODS An online survey on the management of DLGG patients was sent to 28 expert centers from the European Low-Grade Glioma Network (ELGGN) in May 2015. It contained 40 specific questions addressing the modalities of use of chemotherapy in these patients. RESULTS The survey demonstrated a significant heterogeneity in practice regarding the initial management of DLGG patients and the use of chemotherapy. Interestingly, radiation therapy combined with the procarbazine, CCNU (lomustine), and vincristine regimen has not imposed itself as the gold-standard treatment after surgery, despite the results of the Radiation Therapy Oncology Group 9802 study. Temozolomide is largely used as first-line treatment after surgical resection for high-risk DLGG patients, or at progression. CONCLUSIONS The heterogeneity in the management of patients with DLGG demonstrates that many questions regarding the postoperative strategy and the use of chemotherapy remain unanswered. Our survey reveals a high recruitment potential within the ELGGN for retrospective or prospective studies to generate new data regarding these issues.
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Affiliation(s)
- Amélie Darlix
- Department of Medical Oncology, Institut du Cancer de Montpellier, University of Montpellier, France
| | | | | | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Austria
| | | | - Martin Voss
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Frankfurt, Germany
| | - Joachim Steinbach
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Frankfurt, Germany
| | | | - John Goodden
- Leeds General Infirmary and North East Paediatric Neuroscience Network, Leeds, United Kingdom
| | - Giuseppe Banna
- Department of Neurosurgery and Gammaknife, Cannizzaro General Hospital, Catania, Italy
| | - Concetta Di Blasi
- Department of Neurosurgery and Gammaknife, Cannizzaro General Hospital, Catania, Italy
| | - Nicolas Foroglou
- Aristotle University of Thessaloniki, Department of Neurosurgery, AHEPA University Hospital, Greece
| | - Andreas F Hottinger
- Departments of Clinical Neurosciences and Oncology, Centre Hospitalier Universitaire Vaudois and Lausanne University, Switzerland
| | | | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France, and Paris Descartes University, Sorbonne Paris Cité, France
| | - Hugues Duffau
- Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
- Department of Neurosurgery, Montpellier University Hospital, France
| | - Geert-Jan Rutten
- Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Fabien Almairac
- Department of Neurosurgery, University Hospital of Nice, France
| | - Denys Fontaine
- Department of Neurosurgery, University Hospital of Nice, France
| | - Luc Taillandier
- Department of Neurooncology, Nancy Neurological Hospital, France
| | | | | | - Gord von Campe
- Department of Neurosurgery, Medical University of Graz, Austria
| | | | - Marie Blonski
- Department of Neurooncology, Nancy Neurological Hospital, France
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18
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Hejrati N, Spieler D, Samuel R, Regli L, Weyerbrock A, Surbeck W. Conscious Experience and Psychological Consequences of Awake Craniotomy. World Neurosurg 2019; 129:e381-e386. [PMID: 31136840 DOI: 10.1016/j.wneu.2019.05.156] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Experiencing cranial surgery under awake conditions may expose patients to considerable psychological strain. METHODS This study aimed to investigate the occurrence and course of psychological sequelae following awake craniotomy (AC) for brain tumors in a series of 20 patients using a broad, validated psychological assessment preoperatively, intraoperatively, postoperatively and a standardized follow-up of 3 months. In addition, the association of the preoperative psychological condition (including, but not limited to, anxiety and fear) with perioperative pain perception and interference was assessed. RESULTS AC did not induce any shift in the median levels of anxiety, depression, and stress symptoms already present prior to the procedure. Furthermore, anxiety and depression were all moderately to strongly associated over time (all P < 0.05). Stress symptoms also correlated positively over all times of measurement. Stress 3 days after surgery was strongly associated with stress 3 months after surgery (P < 0.001), whereas the correlation between preoperative and immediate postoperative stress showed a statistical trend (P = 0.07). Preoperative fear was not related to intraoperative pain, but to pain and its interference with daily activity on the third postoperative day (P < 0.001 and P < 0.01, respectively). CONCLUSIONS Postoperative psychological symptoms clearly correlated with their corresponding preoperative symptoms. Thus, mental health was not negatively affected by the AC experience in our series. Intraoperative fear and pain were not related to the preoperative psychological condition. However, preoperative fear and anxiety were positively related with pain and its interference with daily activity in the immediate postoperative period.
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Affiliation(s)
- Nader Hejrati
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Derek Spieler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Albert-Ludwigs University, Freiburg, Germany
| | - Robin Samuel
- Research Unit INSIDE, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Werner Surbeck
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland.
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19
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Brain atlas for assessing the impact of tumor location on perioperative quality of life in patients with high-grade glioma: A prospective population-based cohort study. NEUROIMAGE-CLINICAL 2019; 21:101658. [PMID: 30655192 PMCID: PMC6412075 DOI: 10.1016/j.nicl.2019.101658] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 12/17/2018] [Accepted: 01/04/2019] [Indexed: 11/25/2022]
Abstract
Background Tumor location is important for surgical decision making. Particular attention is paid to regions that contain sensorimotor and language functions, but it is unknown if these are the most important regions from the patients' perspective. Objective To develop an atlas for depicting and assessing the potential importance of tumor location for perioperative health-related quality of life (HRQoL) in patients with newly diagnosed high-grade glioma. Methods Patient-reported HRQoL data and semi-automatically segmented preoperative 3D MRI-images were combined in 170 patients. The images were registered to a standardized space where the individual tumors were given the values and color intensity of the corresponding HRQoL. Descriptive brain maps of HRQoL, defined quantitative analyses, and voxel-based lesion symptom mapping comparing patients with tumors in different locations were made. Results There was no statistical difference in overall perioperative HRQoL between patients with tumors located in left or right hemisphere, between patients with tumors in different lobes, or between patients with tumors located in non-eloquent, near eloquent, or eloquent areas. Patients with tumors involving the internal capsule, and patients with preoperative motor symptoms and postoperative motor deficits, reported significantly worse overall HRQoL-scores. Conclusions The impact of anatomical tumor location on overall perioperative HRQoL seems less than frequently believed, and the distinction between critical and less critical brain regions seems more unclear according to the patients than perhaps when judged by physicians. However, worse HRQoL was found in patients with tumors in motor-related regions, indicating that these areas are crucial also from the patients' perspective. The impact of tumor location on patient-reported overall quality of life is low. There is no “dominant hemisphere” from the patients' perspective. Motor related regions seem to be most crucial for the patients.
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20
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Li J, Wang X, Wang C, Sun L. The moderating role of depression on the association between posttraumatic growth and health-related quality of life in low-grade glioma patients in China. PSYCHOL HEALTH MED 2018; 24:643-653. [PMID: 30526021 DOI: 10.1080/13548506.2018.1557714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Junyi Li
- School of Teacher Education and Psychology, Sichuan Normal University, Chengdu, China
| | - Xiaoyu Wang
- Department of Neurosurgery, West China Hospital, Chengdu, China
| | - Chengwei Wang
- Department of Neurosurgery, West China Hospital, Chengdu, China
| | - Lijun Sun
- School of Psychology, Xinxiang Medical University, Xinxiang, China
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21
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Abstract
OBJECTIVES To identify the tumors included in the WHO classification of low-grade gliomas, and review the importance of molecular biomarkers and their implication for treatment, prognosis, and outcomes. DATA SOURCES Published research, clinical guidelines, educational articles in oncology journals, and Web-based resources. CONCLUSION Molecular neuropathology has influenced the reclassification of low-grade gliomas and, as such, has provided patient-specific treatments with improving outcomes. IMPLICATIONS FOR NURSING PRACTICE Nurses play a key role in patient education and communication with the patient's interdisciplinary care team. Understanding the molecular neuropathology that determine treatment recommendations and in turn recognizing and identifying complications provides improved patient/caregiver satisfaction and outcomes.
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22
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Hafazalla K, Sahgal A, Jaja B, Perry JR, Das S. Procarbazine, CCNU and vincristine (PCV) versus temozolomide chemotherapy for patients with low-grade glioma: a systematic review. Oncotarget 2018; 9:33623-33633. [PMID: 30263090 PMCID: PMC6154749 DOI: 10.18632/oncotarget.25890] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/16/2018] [Indexed: 11/25/2022] Open
Abstract
Low-grade gliomas (LGG) encompass a heterogeneous group of tumors that are clinically, histologically and molecularly diverse. Treatment decisions for patients with LGG are directed toward improving upon the natural history while limiting treatment-associated toxiceffects. Recent evidence has documented a utility for adjuvant chemotherapy with procarbazine, CCNU (lomustine), and vincristine (PCV) or temozolomide (TMZ). We sought to determine the comparative utility of PCV and TMZ for patients with LGG, particularly in context of molecular subtype. A literature search of PubMed was conducted to identify studies reporting patient response to PCV, TMZ, or a combination of chemotherapy and radiation therapy (RT). Eligibility criteria included patients 16 years of age and older, notation of LGG subtype, and report of progression-free survival (PFS), overall survival (OS), and treatment course. Level I, II, and III data were included. Adjuvant therapy with PCV resulted in prolonged PFS and OS in patients with newly diagnosed high-risk LGG. This benefit was accrued most significantly by patients with tumors harboring 1p/19q codeletion and IDH1 mutation. Adjuvant therapy with temozolomide was associated with lower toxicity than therapy with PCV. In patients with LGG with an unfavorable natural history, such as with intact 1p/19q and wild-type IDH1, RT/TMZ plus adjuvant TMZ may be the best option. Patients with biologically favorable high-risk LGG are likely to derive the most benefit from RT and adjuvant PCV.
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Affiliation(s)
- Karim Hafazalla
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Blessing Jaja
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - James R Perry
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sunit Das
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
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23
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Health-Related Quality of Life and Posttraumatic Growth in Low-Grade Gliomas in China: A Prospective Study. World Neurosurg 2018; 111:e24-e31. [DOI: 10.1016/j.wneu.2017.11.122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 11/22/2022]
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24
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Persaud-Sharma D, Burns J, Govea M, Kashan S. Cerebral gliomas: Treatment, prognosis and palliative alternatives. PROGRESS IN PALLIATIVE CARE 2018. [DOI: 10.1080/09699260.2017.1417805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dharam Persaud-Sharma
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Joseph Burns
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Marien Govea
- The Honors College, Florida International University Honors College Bioethics, Miami, FL 33199, USA
| | - Sanaz Kashan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
- Palliative Care Fellowship Director, Internal Medicine Teaching Faculty, Aventura Hospital & Medical Center, Aventura, FL 33180, USA
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Wahl M, Phillips JJ, Molinaro AM, Lin Y, Perry A, Haas-Kogan DA, Costello JF, Dayal M, Butowski N, Clarke JL, Prados M, Nelson S, Berger MS, Chang SM. Chemotherapy for adult low-grade gliomas: clinical outcomes by molecular subtype in a phase II study of adjuvant temozolomide. Neuro Oncol 2017; 19:242-251. [PMID: 27571885 DOI: 10.1093/neuonc/now176] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Optimal adjuvant management of adult low-grade gliomas is controversial. Recently described tumor classification based on molecular subtype has the potential to individualize adjuvant therapy but has not yet been evaluated as part of a prospective trial. Methods Patients aged 18 or older with newly diagnosed World Health Organization grade II low-grade gliomas and gross residual disease after surgical resection were enrolled in the study. Patients received monthly cycles of temozolomide for up to 1 year or until disease progression. For patients with available tissue, molecular subtype was assessed based upon 1p/19q codeletion and isocitrate dehydrogenase-1 R132H mutation status. The primary outcome was radiographic response rate; secondary outcomes included progression-free survival (PFS) and overall survival (OS). Results One hundred twenty patients were enrolled with median follow-up of 7.5 years. Overall response rate was 6%, with median PFS and OS of 4.2 and 9.7 years, respectively. Molecular subtype was associated with rate of disease progression during treatment (P<.001), PFS (P=.007), and OS (P<.001). Patients with 1p/19q codeletion demonstrated a 0% risk of progression during treatment. In an exploratory analysis, pretreatment lesion volume was associated with both PFS (P<.001) and OS (P<.001). Conclusions While our study failed to meet the primary endpoint for objective radiographic response, patients with high-risk low-grade glioma receiving adjuvant temozolomide demonstrated a high rate of radiographic stability and favorable survival outcomes while meaningfully delaying radiotherapy. Patients with 1p/19q codeletion are potential candidates for omission of adjuvant radiotherapy, but further work is needed to directly compare chemotherapy with combined modality therapy.
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Affiliation(s)
- Michael Wahl
- Department of Radiation Oncology, University of California, San Francisco, USA
| | - Joanna J Phillips
- Department of Pathology, University of California, San Francisco, USA.,Department of Neurosurgery, University of California, San Francisco, USA
| | - Annette M Molinaro
- Department of Neurosurgery, University of California, San Francisco, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco , USA
| | - Yi Lin
- Department of Neurosurgery, University of California, San Francisco, USA.,Department of Neurosurgery, First Affiliated Hospital of China Medical University, China
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, USA.,Department of Neurosurgery, University of California, San Francisco, USA
| | - Daphne A Haas-Kogan
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Joseph F Costello
- Department of Neurosurgery, University of California, San Francisco, USA
| | - Manisha Dayal
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Nicholas Butowski
- Department of Neurosurgery, University of California, San Francisco, USA
| | - Jennifer L Clarke
- Department of Neurosurgery, University of California, San Francisco, USA.,Department of Neurology, University of California, San Francisco, USA
| | - Michael Prados
- Department of Neurosurgery, University of California, San Francisco, USA
| | - Sarah Nelson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA.,Department of Neurology, University of California, San Francisco, USA.,Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, USA
| | - Mitchel S Berger
- Department of Neurosurgery, University of California, San Francisco, USA
| | - Susan M Chang
- Department of Neurosurgery, University of California, San Francisco, USA
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Tanti MJ, Marson AG, Jenkinson MD. Epilepsy and adverse quality of life in surgically resected meningioma. Acta Neurol Scand 2017; 136:246-253. [PMID: 27861722 DOI: 10.1111/ane.12711] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Meningiomas are common intracranial tumors, and despite surgery or therapy with anti-epileptic drugs (AEDs), many patients suffer from seizures. Epilepsy has a significant impact on quality of life (QoL) in non-tumor populations, but the impact of epilepsy on QoL in patients with meningioma is unknown. Our aim was to evaluate the impact of epilepsy on QoL in patients that have undergone resection of a benign meningioma. MATERIALS AND METHODS We recruited meningioma patients without epilepsy (n=109), meningioma patients with epilepsy (n=56), and epilepsy patients without meningioma (n=64). QoL was measured with the Short Form 36 version 2 (SF-36), the Functional Assessment of Cancer Therapy (FACT-BR), and the Liverpool Adverse Events Profile (LAEP). Regression analyses identified significant determinants of QoL. RESULTS Patients with meningioma and epilepsy had poorer QoL scores than meningioma patients without epilepsy in all measures. In FACT-BR, this difference was significant. Multiple regression analyses demonstrated that current AED use had a greater impact on QoL scores than recent seizures. Other variables associated with impaired QoL included depression, unemployment, and meningioma attributed symptoms. CONCLUSIONS Epilepsy has a negative impact on quality of life in patients with benign meningioma. AED use is correlated with impaired QoL and raised LAEP scores, suggesting that AEDs and adverse effects may have led to impaired QoL in our meningioma patients with epilepsy. The severity of epilepsy in our meningioma population was comparatively mild; therefore, a more conservative approach to AED therapy may be indicated in an attempt to minimize adverse effects.
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Affiliation(s)
- M. J. Tanti
- The Walton Centre NHS Foundation Trust; Fazakerley Liverpool UK
- School of Medicine; University of Liverpool; Liverpool UK
- Institute of Translational Medicine; University of Liverpool; Liverpool UK
| | - A. G. Marson
- The Walton Centre NHS Foundation Trust; Fazakerley Liverpool UK
- Institute of Translational Medicine; University of Liverpool; Liverpool UK
| | - M. D. Jenkinson
- The Walton Centre NHS Foundation Trust; Fazakerley Liverpool UK
- Institute of Infection and Global Health; University of Liverpool; Liverpool UK
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Bogdańska M, Bodnar M, Belmonte-Beitia J, Murek M, Schucht P, Beck J, Pérez-García V. A mathematical model of low grade gliomas treated with temozolomide and its therapeutical implications. Math Biosci 2017; 288:1-13. [DOI: 10.1016/j.mbs.2017.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/28/2016] [Accepted: 02/02/2017] [Indexed: 12/14/2022]
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Gagliardi F, Bailo M, Spina A, Donofrio CA, Boari N, Franzin A, Fava A, Del Vecchio A, Bolognesi A, Mortini P. Gamma Knife Radiosurgery for Low-Grade Gliomas: Clinical Results at Long-Term Follow-Up of Tumor Control and Patients' Quality of Life. World Neurosurg 2017; 101:540-553. [PMID: 28216397 DOI: 10.1016/j.wneu.2017.02.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE First-line therapy for low-grade gliomas (LGGs) is surgery, in some cases followed by radiotherapy and chemotherapy. Gamma Knife radiosurgery (GKRS) has gained more relevance in the management of these tumors. The aim of this study was to assess efficacy and safety of GKRS for treatment of LGGs. METHODS Between 2001 and 2014, 42 treatments were performed on 39 patients harboring LGGs; 48% of patients underwent previous surgery, and 20.5% underwent previous radiotherapy. Mean tumor volume was 2.7 cm3, and median margin dose was 15 Gy. RESULTS Mean follow-up was 60.5 months (range, 6-164 months). Actuarial progression-free survival was 74.9%, 52.8%, and 39.1% at 1 year, 5 years, and 10 years; actuarial overall survival was 97.4%, 94.6%, and 91.8% at 9 months, 1 year, and 5 years. Solid tumor control was achieved in 69.2% of patients, whereas cystic enlargement was recorded in 12.9% of cases. At last follow-up, volume reduction was recorded in 57.7% of cases, and median volume decreased by 33.3%. Clinical improvement was observed in 52.4% of patients. Karnofsky performance scale score was improved in 15 patients (45.5%), unchanged in 17 patients (51.5%), and worsened in 1 patient (3%). Mean posttreatment scores of 36-item short form health survey domains did not significantly differ from scores in a healthy Italian population. CONCLUSIONS This study confirms safety and effectiveness of GKRS for LGGs in controlling tumor growth, relevantly improving patients' overall and progression-free survival. GKRS improved patients' functional performance and quality of life, optimizing social functioning and minimizing disease-related psychological impact.
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Affiliation(s)
- Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Carmine A Donofrio
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Nicola Boari
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Alberto Franzin
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Arianna Fava
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Antonella Del Vecchio
- Service of Medical Physics, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Angelo Bolognesi
- Service of Radiation Oncology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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Reijneveld JC, Taphoorn MJB, Coens C, Bromberg JEC, Mason WP, Hoang-Xuan K, Ryan G, Hassel MB, Enting RH, Brandes AA, Wick A, Chinot O, Reni M, Kantor G, Thiessen B, Klein M, Verger E, Borchers C, Hau P, Back M, Smits A, Golfinopoulos V, Gorlia T, Bottomley A, Stupp R, Baumert BG. Health-related quality of life in patients with high-risk low-grade glioma (EORTC 22033-26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol 2016; 17:1533-1542. [PMID: 27686943 DOI: 10.1016/s1470-2045(16)30305-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/28/2016] [Accepted: 07/04/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Temozolomide chemotherapy versus radiotherapy in patients with a high-risk low-grade glioma has been shown to have no significant effect on progression-free survival. If these treatments have a different effect on health-related quality of life (HRQOL), it might affect the choice of therapy. We postulated that temozolomide compromises HRQOL and global cognitive functioning to a lesser extent than does radiotherapy. METHODS We did a prospective, phase 3, randomised controlled trial at 78 medical centres and large hospitals in 19 countries. We enrolled adult patients (aged ≥18 years) with histologically confirmed diffuse (WHO grade II) astrocytoma, oligodendroglioma, or mixed oligoastrocytoma, with a WHO performance status of 2 or lower, without previous chemotherapy or radiotherapy, who needed active treatment other than surgery. We randomly assigned eligible patients (1:1) using a minimisation technique, stratified by WHO performance status (0-1 vs 2), age (<40 years vs ≥40 years), presence of contrast enhancement on MRI, chromosome 1p status (deleted vs non-deleted vs indeterminate), and the treating medical centre, to receive either radiotherapy (50·4 Gy in 28 fractions of 1·8 Gy for 5 days per week up to 6·5 weeks) or temozolomide chemotherapy (75 mg/m2 daily, for 21 of 28 days [one cycle] for 12 cycles). The primary endpoint was progression-free survival (results published separately); here, we report the results for two key secondary endpoints: HRQOL (assessed using the European Organisation for Research and Treatment of Cancer's [EORTC] QLQ-C30 [version 3] and the EORTC Brain Cancer Module [QLQ-BN20]) and global cognitive functioning (assessed using the Mini-Mental State Examination [MMSE]). We did analyses on the intention-to-treat population. This study is closed and is registered at EudraCT, number 2004-002714-11, and at ClinicalTrials.gov, number NCT00182819. FINDINGS Between Dec 6, 2005, and Dec 21, 2012, we randomly assigned 477 eligible patients to either radiotherapy (n=240) or temozolomide chemotherapy (n=237). The difference in HRQOL between the two treatment groups was not significant during the 36 months' follow-up (mean between group difference [averaged over all timepoints] 0·06, 95% CI -4·64 to 4·75, p=0·98). At baseline, 32 (13%) of 239 patients who received radiotherapy and 32 (14%) of 236 patients who received temozolomide chemotherapy had impaired cognitive function, according to the MMSE scores. After randomisation, five (8%) of 63 patients who received radiotherapy and three (6%) of 54 patients who received temozolomide chemotherapy and who could be followed up for 36 months had impaired cognitive function, according to the MMSE scores. No significant difference was recorded between the groups for the change in MMSE scores during the 36 months of follow-up. INTERPRETATION The effect of temozolomide chemotherapy or radiotherapy on HRQOL or global cognitive functioning did not differ in patients with low-grade glioma. These results do not support the choice of temozolomide alone over radiotherapy alone in patients with high-risk low-grade glioma. FUNDING Merck Sharp & Dohme-Merck & Co, National Cancer Institute, Swiss Cancer League, National Institute for Health Research, Cancer Research UK, Canadian Cancer Society Research Institute, National Health and Medical Research Council, European Organisation for Research and Treatment of Cancer Cancer Research Fund.
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Affiliation(s)
- Jaap C Reijneveld
- Department of Neurology, Brain Tumor Centre Amsterdam, VU University Medical Centre and Academic Medical Centre, Amsterdam, Netherlands.
| | - Martin J B Taphoorn
- Department of Neurology, Medical Centre Haaglanden and Leiden University Medical Centre, The Hague, Netherlands
| | - Corneel Coens
- Department of Quality of Life, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Jacoline E C Bromberg
- Department of Neuro-oncology, Erasmus MC University MC Cancer Centre, Rotterdam, Netherlands
| | - Warren P Mason
- Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Khê Hoang-Xuan
- APHP, Department of Neurology, Pitié-Salpêtrière Hospital, UPMC, Sorbonne Universités, IHU, Paris, France
| | - Gail Ryan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Mohamed Ben Hassel
- Department of Medical Oncology and Department of Radiotherapy, Centre Eugène Marquis, Rennes, France
| | - Roelien H Enting
- Department of Neurology, University of Groningen, University Medical Centre, Groningen, Netherlands
| | - Alba A Brandes
- Department of Medical Oncology, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - Antje Wick
- Neurology Clinic, University of Heidelberg Medical Centre and NCT Neurooncology in DKTK of the German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Olivier Chinot
- Aix Marseille Universite, APHM, Hopital de La Timone, Department of Neuro-Oncology, Marseille, France
| | - Michele Reni
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guy Kantor
- Department of Radiotherapy, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, Bordeaux, France; Department of Radiotherapy, University Bordeaux Segalen, Bordeaux, France
| | | | - Martin Klein
- Department of Medical Psychology, Brain Tumor Centre Amsterdam, VU University Medical Centre and Academic Medical Centre, Amsterdam, Netherlands
| | - Eugenie Verger
- Department of Radiation-Oncology, Hospital Clinic Universitari, Barcelona, Spain
| | - Christian Borchers
- Department of Neurology, University Hospital Tübingen, Tübingen, Germany; Centre of Neuromedicine, North-West-Hospital Sanderbusch, Sande, Germany
| | - Peter Hau
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Michael Back
- Department of Radiation Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Anja Smits
- Department of Neuroscience, Neurology, Uppsala University and University Hospital, Uppsala, Sweden
| | - Vassilis Golfinopoulos
- Medical Department, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Thierry Gorlia
- Department of Statistics, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Andrew Bottomley
- Department of Quality of Life, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Roger Stupp
- Department of Clinical Neurosciences, Department of Neurosurgery, and Department of Oncology, University Hospital Lausanne, Lausanne, Switzerland
| | - Brigitta G Baumert
- Department of Medical Oncology and Cancer Centre, University Hospital Zurich, Zurich, Switzerland; Department of Radiation-Oncology (MAASTRO), Maastricht University Medical Centre (MUMC) and GROW (School for Oncology), Maastricht, Netherlands; Department of Radiation-Oncology, MediClin Robert-Janker-Clinic, Clinical Cooperation Unit Neuro-oncology, University Bonn Medical Centre, Bonn, Germany
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Gai XJ, Wei YM, Tao HM, An DZ, Sun JT, Li BS. Comparison of long-term survival between temozolomide-based chemoradiotherapy and radiotherapy alone for patients with low-grade gliomas after surgical resection. Onco Targets Ther 2016; 9:5117-21. [PMID: 27574452 PMCID: PMC4993403 DOI: 10.2147/ott.s108989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose This study was designed to compare the survival outcomes of temozolomide-based chemoradiotherapy (TMZ + RT) vs radiotherapy alone (RT-alone) for low-grade gliomas (LGGs) after surgical resection. Patients and methods In this retrospective analysis, we reviewed postoperative records of 69 patients with LGGs treated with TMZ + RT (n=31) and RT-alone (n=38) at the Shandong Cancer Hospital Affiliated to Shandong University between June 2011 and December 2013. Patients in the TMZ + RT group were administered 50–100 mg oral TMZ every day until the radiotherapy regimen was completed. Results The median follow-up since surgery was 33 months and showed no significant intergroup differences (P=0.06). There were statistically significant intergroup differences in the progression-free survival rate (P=0.037), with 83.9% for TMZ-RT group and 60.5% for RT-alone group. The overall 2-year overall survival (OS) rate was 89.86%. Age distribution (≥45 years and <45 years) and resection margin (complete resection or not) were significantly associated with OS (P=0.03 and P=0.004, respectively). Conclusion Although no differences were found in the 2-year OS between the TMZ + RT and RT-alone groups, there was a trend toward increased 2-year progression-free survival in the TMZ + RT group. With better tolerability, concurrent TMZ chemoradiotherapy may be beneficial for postoperative patients with LGGs. Age distribution and surgical margin are likely potential indicators of disease prognosis. The possible differences in long-term survival between the two groups and the links between prognostic factors and long-term survival may be worthy of further investigation.
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Affiliation(s)
- Xiu-Juan Gai
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China; Department of Radiation Oncology VI, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Yu-Mei Wei
- Department of Radiation Oncology VI, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Heng-Min Tao
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China; Department of Radiation Oncology VI, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Dian-Zheng An
- Department of Radiation Oncology VI, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Jia-Teng Sun
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China; Department of Radiation Oncology VI, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Bao-Sheng Li
- Department of Radiation Oncology VI, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
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Fountain DM, Allen D, Joannides AJ, Nandi D, Santarius T, Chari A. Reporting of patient-reported health-related quality of life in adults with diffuse low-grade glioma: a systematic review. Neuro Oncol 2016; 18:1475-1486. [PMID: 27194147 DOI: 10.1093/neuonc/now107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/19/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Patient-reported health-related quality of life (HRQoL) analysis can provide important information for managing the balance between treatment benefits and treatment-related adverse effects on quality of life (QoL). This systematic review sought to identify the range of HRQoL measures used for patients with diffuse hemispheric WHO grade II glioma (DLGG) and assess the quality of HRQoL reporting. METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched for full-text English articles reporting HRQoL outcomes in adult patients with DLGG. RESULTS Eleven different QoL measures were used across the 26 included studies, none of which has been validated in patients with DLGG. Heterogeneity of study design prevented pooled analysis of data investigating the effect of interventions or establishing long-term HRQoL. Low rates of participation at baseline (mean: 64.0%) and high rates of subsequent dropout (2.1% per month) were identified. Five studies gave statistical methods to deal with missing data or provided evidence of clinical significance of HRQoL results. CONCLUSIONS The results demonstrate a paucity and heterogeneity of reporting of HRQoL in the DLGG literature, highlighting the need for a standardized assessment schedule and set of validated quality-of-life measures for future studies.
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Affiliation(s)
- Daniel M Fountain
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK (D.M.F., A.J.J., T.S.); Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK (D.M.F, A.J.J, T.S); Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK (D.A, D.N, A.C); Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK (D.A, D.N, A.C)
| | - Dominic Allen
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK (D.M.F., A.J.J., T.S.); Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK (D.M.F, A.J.J, T.S); Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK (D.A, D.N, A.C); Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK (D.A, D.N, A.C)
| | - Alexis J Joannides
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK (D.M.F., A.J.J., T.S.); Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK (D.M.F, A.J.J, T.S); Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK (D.A, D.N, A.C); Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK (D.A, D.N, A.C)
| | - Dipankar Nandi
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK (D.M.F., A.J.J., T.S.); Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK (D.M.F, A.J.J, T.S); Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK (D.A, D.N, A.C); Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK (D.A, D.N, A.C)
| | - Thomas Santarius
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK (D.M.F., A.J.J., T.S.); Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK (D.M.F, A.J.J, T.S); Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK (D.A, D.N, A.C); Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK (D.A, D.N, A.C)
| | - Aswin Chari
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK (D.M.F., A.J.J., T.S.); Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK (D.M.F, A.J.J, T.S); Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK (D.A, D.N, A.C); Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK (D.A, D.N, A.C)
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Drewes C, Sagberg LM, Jakola AS, Solheim O. Quality of life in patients with intracranial tumors: does tumor laterality matter? J Neurosurg 2016; 125:1400-1407. [PMID: 27015402 DOI: 10.3171/2015.12.jns152252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traditionally, the dominant (usually left) cerebral hemisphere is regarded as the more important one, and everyday clinical decisions are influenced by this view. However, reported results on the impact of lesion laterality are inconsistent in the scarce literature on quality of life (QOL) in patients with brain tumors. The authors aimed to study which cerebral hemisphere is the most important to patients with intracranial tumors with respect to health-related QOL (HRQOL). METHODS Two hundred forty-eight patients with unilateral, unifocal gliomas or meningiomas scheduled for primary surgery were included in this prospective cohort study. Generic HRQOL was measured using the EQ-5D-3L questionnaire preoperatively and after 4-6 weeks. Cross-sectional and longitudinal analyses of data were performed. RESULTS Tumor volumes were significantly larger in right-sided tumors at diagnosis, and language or speech problems were more common in left-sided lesions. Otherwise, no differences existed in baseline data. The median EQ-5D-3L index was 0.73 (range -0.24 to 1.00) in patients with right-sided tumors and 0.76 (range -0.48 to 1.00) in patients with left-sided tumors (p = 0.709). Due to the difference in tumor volumes at baseline, histopathology and tumor volumes were matched in 198 patients. EQ-5D-3L index scores in this 1:1 matched analysis were 0.74 (range -0.7 to 1.00) for patients with right-sided and 0.76 (range -0.48 to 1.00) for left-sided lesions (p = 0.342). In the analysis of longitudinal data, no association was found between tumor laterality and postoperative EQ-5D-3L index scores (p = 0.957) or clinically significant change in HRQOL following surgery (p = 0.793). CONCLUSIONS In an overall patient-reported QOL perspective, tumor laterality does not appear to be of significant importance for generic HRQOL in patients with intracranial tumors. This may imply that right-sided cerebral functions are underestimated by clinicians.
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Affiliation(s)
| | - Lisa Millgård Sagberg
- Neurosurgery, St. Olavs University Hospital, Trondheim.,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Asgeir Store Jakola
- Neurosurgery, St. Olavs University Hospital, Trondheim.,Department of Neurosurgery, Gothenburg University Hospital, Gothenburg; and.,Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Ole Solheim
- Neurosurgery, St. Olavs University Hospital, Trondheim.,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
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Claus EB, Walsh KM, Wiencke JK, Molinaro AM, Wiemels JL, Schildkraut JM, Bondy ML, Berger M, Jenkins R, Wrensch M. Survival and low-grade glioma: the emergence of genetic information. Neurosurg Focus 2015; 38:E6. [PMID: 25552286 DOI: 10.3171/2014.10.focus12367] [Citation(s) in RCA: 289] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Significant gaps exist in our understanding of the causes and clinical management of glioma. One of the biggest gaps is how best to manage low-grade (World Health Organization [WHO] Grade II) glioma. Low-grade glioma (LGG) is a uniformly fatal disease of young adults (mean age 41 years), with survival averaging approximately 7 years. Although LGG patients have better survival than patients with high-grade (WHO Grade III or IV) glioma, all LGGs eventually progress to high-grade glioma and death. Data from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute suggest that for the majority of LGG patients, overall survival has not significantly improved over the past 3 decades, highlighting the need for intensified study of this tumor. Recently published research suggests that historically used clinical variables are not sufficient (and are likely inferior) prognostic and predictive indicators relative to information provided by recently discovered tumor markers (e.g., 1p/19q deletion and IDH1 or IDH2 mutation status), tumor expression profiles (e.g., the proneural profile) and/or constitutive genotype (e.g., rs55705857 on 8q24.21). Discovery of such tumor and constitutive variation may identify variables needed to improve randomization in clinical trials as well as identify patients more sensitive to current treatments and targets for improved treatment in the future. This article reports on survival trends for patients diagnosed with LGG within the United States from 1973 through 2011 and reviews the emerging role of tumor and constitutive genetics in refining risk stratification, defining targeted therapy, and improving survival for this group of relatively young patients.
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Boele FW, Douw L, Reijneveld JC, Robben R, Taphoorn MJ, Aaronson NK, Heimans JJ, Klein M. Health-Related Quality of Life in Stable, Long-Term Survivors of Low-Grade Glioma. J Clin Oncol 2015; 33:1023-9. [DOI: 10.1200/jco.2014.56.9079] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose Patients with low-grade glioma (LGG) often experience long periods of stable disease, emphasizing the importance of maintaining good health-related quality of life (HRQOL). We assessed the changes in HRQOL in long-term survivors of WHO grade I or II astrocytoma, oligodendroglioma, or oligoastrocytoma with clinically and radiologically stable disease. Patients and Methods Patients completed self-report measures of generic HRQOL (Short Form-36 [SF-36]) and disease-specific HRQOL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire–Brain Cancer Module). Assessments took place at midterm and long-term follow-up, on average 6 and 12 years after histologic diagnosis and initial treatment, respectively. Comparisons between patients with LGG and individually matched healthy controls were made, and change within the patients with LGG was calculated, as was minimal detectable change. Results Although no statistically significant differences between patients with LGG and healthy matched controls were found at midterm follow-up, patients with LGG had worse physical role functioning (P = .004) and general health perceptions (P = .004) than controls at long-term follow-up. Within patients with stable LGG (n = 65), physical HRQOL (the SF-36 physical component summary and the physical functioning subscale) was significantly worse at long-term than at midterm follow-up (both P < .001). Although 48% of patients improved or remained stable on all HRQOL scales, 38.5% of patients experienced detectable decline on one or more scales. Conclusion Although HRQOL remains mostly preserved in the majority of patients with LGG, a subset of patients experience detectable decline on one or more HRQOL scales despite long-term stable disease. For this subgroup, further research is recommended to better aid patients in dealing with the consequences of LGG.
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Affiliation(s)
- Florien W. Boele
- Florien W. Boele, Linda Douw, Jaap C. Reijneveld, Rianne Robben, Jan J. Heimans, and Martin Klein, VU University Medical Center; Neil K. Aaronson, Netherlands Cancer Institute, Amsterdam; and Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, the Netherlands
| | - Linda Douw
- Florien W. Boele, Linda Douw, Jaap C. Reijneveld, Rianne Robben, Jan J. Heimans, and Martin Klein, VU University Medical Center; Neil K. Aaronson, Netherlands Cancer Institute, Amsterdam; and Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, the Netherlands
| | - Jaap C. Reijneveld
- Florien W. Boele, Linda Douw, Jaap C. Reijneveld, Rianne Robben, Jan J. Heimans, and Martin Klein, VU University Medical Center; Neil K. Aaronson, Netherlands Cancer Institute, Amsterdam; and Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, the Netherlands
| | - Rianne Robben
- Florien W. Boele, Linda Douw, Jaap C. Reijneveld, Rianne Robben, Jan J. Heimans, and Martin Klein, VU University Medical Center; Neil K. Aaronson, Netherlands Cancer Institute, Amsterdam; and Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, the Netherlands
| | - Martin J.B. Taphoorn
- Florien W. Boele, Linda Douw, Jaap C. Reijneveld, Rianne Robben, Jan J. Heimans, and Martin Klein, VU University Medical Center; Neil K. Aaronson, Netherlands Cancer Institute, Amsterdam; and Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, the Netherlands
| | - Neil K. Aaronson
- Florien W. Boele, Linda Douw, Jaap C. Reijneveld, Rianne Robben, Jan J. Heimans, and Martin Klein, VU University Medical Center; Neil K. Aaronson, Netherlands Cancer Institute, Amsterdam; and Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, the Netherlands
| | - Jan J. Heimans
- Florien W. Boele, Linda Douw, Jaap C. Reijneveld, Rianne Robben, Jan J. Heimans, and Martin Klein, VU University Medical Center; Neil K. Aaronson, Netherlands Cancer Institute, Amsterdam; and Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, the Netherlands
| | - Martin Klein
- Florien W. Boele, Linda Douw, Jaap C. Reijneveld, Rianne Robben, Jan J. Heimans, and Martin Klein, VU University Medical Center; Neil K. Aaronson, Netherlands Cancer Institute, Amsterdam; and Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, the Netherlands
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Abstract
Low-grade gliomas (LGGs) represent the most common childhood brain tumors and are a histologically heterogenous group of tumors. Most LGGs are surgically resectable with excellent 10-year overall survival outcomes of more than 90 % with surgery alone. Tumors not amenable to surgical resection and those with an aggressive biology are more challenging to treat. Conventional radiotherapy is a more efficacious method of long-term tumor control than chemotherapy. However, radiation is associated with significant cognitive, endocrine, and cerebrovascular late effects, making chemotherapy an often-preferred modality over radiotherapy, especially in younger children. Multiple chemotherapy regimens have been evaluated over the past few decades with comparable survival outcomes and differing toxicity profiles. Newer regimens containing antiangiogenic agents also show promise. Recent molecular studies have implicated the BRAF oncogene, a key regulator of the MAPK pathway, and the AKT/mTOR pathway in pediatric LGG tumorigenesis. This has opened up promising new avenues for targeted therapy, with many agents currently under investigation.
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Schiavolin S, Quintas R, Pagani M, Brock S, Acerbi F, Visintini S, Cusin A, Schiariti M, Broggi M, Ferroli P, Leonardi M. Quality of life, disability, well-being, and coping strategies in patients undergoing neurosurgical procedures: preoperative results in an Italian sample. ScientificWorldJournal 2014; 2014:790387. [PMID: 25538963 PMCID: PMC4235741 DOI: 10.1155/2014/790387] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/03/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this paper is to present the preliminary results of QoL, well-being, disability, and coping strategies of patients before neurosurgical procedure. METHODS We analysed data on preoperative quality of life (EUROHIS-QoL), disability (WHODAS-II), well-being (PGWB-S), coping strategies (Brief COPE), and functional status (KPS score) of a sample of patients with brain tumours and cerebrovascular and spinal degenerative disease admitted to Neurological Institute Carlo Besta. Statistical analysis was performed to illustrate the distribution of sociodemographic and clinical data, to compare mean test scores to the respective normative samples, and to investigate the differences between diagnoses, the correlation between tests, and the predictive power of sociodemographic and clinical variables of QoL. RESULTS 198 patients were included in the study. PGWB-S and EUROHIS-QoL scores were significantly lower than normative population. Patients with spinal diseases reported higher scores in WHODAS-II compared with oncological and cerebrovascular groups. Finally sociodemographic and clinical variables were significant predictors of EUROHIS-QoL, in particular PGWB-S and WHODAS-II. CONCLUSION Our preliminary results show that preoperatory period is critical and the evaluation of coping strategies, quality of life, disability, and well-being is useful to plan tailored intervention and for a better management of each patient.
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Affiliation(s)
- Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Rui Quintas
- Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Marco Pagani
- Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Stefano Brock
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Francesco Acerbi
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Sergio Visintini
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Alberto Cusin
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Marco Schiariti
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Morgan Broggi
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Paolo Ferroli
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
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Abstract
Low-grade gliomas (LGGs) are a diverse group of primary brain tumors that often arise in young, otherwise healthy patients and generally have an indolent course with longer-term survival in comparison with high-grade gliomas. Treatment options include observation, surgery, radiation, chemotherapy, or a combined approach, and management is individualized based on tumor location, histology, molecular profile, and patient characteristics. Moreover, in this type of brain tumor with a relatively good prognosis and prolonged survival, the potential benefits of treatment must be carefully weighed against potential treatment-related risks. We review in this article current management strategies for LGG, including surgery, radiotherapy, and chemotherapy. In addition, the importance of profiling the genetic and molecular properties of LGGs in the development of targeted anticancer therapies is also reviewed. Finally, given the prevalence of these tumors in otherwise healthy young patients, the impact of treatment on neurocognitive function and quality of life is also evaluated.
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Affiliation(s)
- Deborah A Forst
- Departments of Neurology, Neurosurgery, and Radiation Oncology, and Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Duffau H. Toward an "active" cognitive assessment in patients with diffuse low-grade glioma. World Neurosurg 2014; 82:e129-31. [PMID: 24636936 DOI: 10.1016/j.wneu.2014.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 03/11/2014] [Indexed: 01/14/2023]
Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier University Medical Center; and the National Institute for Health and Medical Research (INSERM), U1051 Laboratory, Team "Brain Plasticity, Stem Cells and Glial Tumors," Institute for Neurosciences of Montpellier, Montpellier University Medical Center, Montpellier, France.
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Management of low-grade gliomas: a review of patient-perceived quality of life and neurocognitive outcome. World Neurosurg 2014; 82:e299-309. [PMID: 24560709 DOI: 10.1016/j.wneu.2014.02.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 11/08/2013] [Accepted: 02/18/2014] [Indexed: 01/23/2023]
Abstract
Low-grade glioma (LGG) comprises nearly 20% of all central nervous system glial tumors, with approximately 2000-3000 patients diagnosed annually in the United States. Because of their infiltrative ability and aggressive nature, the average 10-year survival is 30% when <90% of the tumor is resected. Since the 1970s, prognosis for LGGs has improved significantly. This improvement is primarily attributable to earlier diagnoses via magnetic resonance imaging scanning, increased awareness of the more favorable oligo component, technical advances in intraoperative neurosurgery, and stratification for young age. Using a number of prognostic factors, LGGs have been classified into low-risk and high-risk subgroups. Optimal therapy for patients with low-risk, supratentorial grade II glioma remains a highly controversial issue in the neuro-oncology community. The concerns regarding the toxicity of therapy often outweigh the benefits of delaying tumor progression. The recommendation for observation is made without full prospective understanding of the impact of radiologic tumor progression on the quality of life (QOL), neurocognitive function (NCF), seizure control, and functional status of these patients. We present a review of the current knowledge of the management of LGG with emphasis upon patient-reported outcomes of QOL, NCF, and seizure control. We also discuss current clinical trials with proposals to evaluate QOL, NCF, and seizure control in patients undergoing observation alone after newly diagnosed low-risk LGG or treatment options for those patients in the high-risk group.
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Jalali R, Dutta D. Factors influencing quality of life in adult patients with primary brain tumors. Neuro Oncol 2013; 14 Suppl 4:iv8-16. [PMID: 23095834 DOI: 10.1093/neuonc/nos205] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We performed a literature review with respect to factors influencing health-related quality of life (QOL) in adults with primary brain tumors. A comprehensive, peer-reviewed literature search was performed including studies examining QOL in adults with high-grade gliomas and low-grade gliomas and in routine neuro-oncology practice. The interpretation and implication of QOL domain scores may be different in high-grade, low-grade, and benign brain tumors. Several patient-related, treatment-related, and sociocultural factors influence QOL scores. Pretreatment baseline QOL domain scores have been shown to be a predictive parameter for survival function. Implementation of QOL scores in routine clinical practice is underused. QOL is an important outcome measure in the treatment of patients with brain tumors and should be incorporated as a surrogate end point along with traditional end points, such as disease-free and overall survival in most current trials.
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Affiliation(s)
- Rakesh Jalali
- NeuroOncology Group, Tata Memorial Hospital, Mumbai, India.
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Shields LBE, Choucair A, Choucair AK. Quality of life measures as a preliminary clinical indicator in patients with primary brain tumors. Surg Neurol Int 2013; 4:48. [PMID: 23646258 PMCID: PMC3640233 DOI: 10.4103/2152-7806.110143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/12/2013] [Indexed: 11/30/2022] Open
Abstract
Background: The health-related quality of life (HRQOL) measures serve as valuable indicators of survival in patients with newly diagnosed primary brain tumors (PBTs). HRQOL outcomes may benefit clinical decision-making by individualizing patient treatment and improving communications between the doctor, patient, and families. Exploring the individual items of the European Organization and Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QOL) measures may be predictive of prognosis. Methods: We prospectively collected the validated HRQOL and standard clinical and radiological measures from 48 patients with newly diagnosed PBT. The patients were followed every 3 months over 2 years. No proxies were allowed. Questionnaire responses were compared between two groups: Patients with recurrence and/or death (n = 26) and patients without a recurrence (n = 22). A total of 17 patients succumbed to a tumor-related death. Statistical analysis utilizing nonparametric t-tests and Wilcoxon sign tests assessed QOL responses. Results: Significant group differences were noted in the QOL measures with more negative responses in the recurrence group. EORTC QLQ-C30 questions revealed a poor global HRQOL scale (P < 0.005) and pain interfering with daily activities (P < 0.05). EORTC QLQ-BN20 questions revealed weakness of the legs (P < 0.05), coordination difficulties (P < 0.005), and unsteady gait (P < 0.05). Hospital Anxiety and Depression Scale (HADS) questions reflected a patient who is slowed down (P < 0.01) and “frightened” (P < 0.05). Conclusion: Our analysis of longitudinal HRQOL measures may shed light on the prognostic significance of HRQOL measures in patients with newly diagnosed PBT. Further research is warranted to determine which selected individual measures of the EORTC QOL measures may be predictive of a patient's progression-free and overall survival and to test their validity and reliability in clinical trials.
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Affiliation(s)
- Lisa B E Shields
- Norton Neuroscience Institute and Norton Cancer Institute, Norton Healthcare, Louisville, KY 40202, USA
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Chiu N, Chiu L, Zeng L, Zhang L, Cella D, Popovic M, Chow R, Lam H, Poon M, Chow E. Quality of Life in Patients With Primary and Metastatic Brain Tumors in the Literature as Assessed by the FACT-Br. World J Oncol 2012; 3:280-285. [PMID: 29147319 PMCID: PMC5649806 DOI: 10.4021/wjon585w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The Functional Assessment of Cancer Therapy-Brain (FACT-Br) is a quality of life (QOL) assessment tool that was originally developed for use in patients with primary brain tumors. However, the tool has also been used to assess QOL in patients with metastatic brain tumors. The purpose of this study is to compare the differences in QOL responses as assessed by the FACT-Br in patients with primary and metastatic brain neoplasms. METHODS A systematic literature search was conducted using the OvidSP platform in MEDLINE (1946 to July Week 2 2012) and EMBASE (1980 to 2012 Week 28). Articles in which the FACT-Br was used as a QOL assessment for patients with malignant brain tumors (both primary and metastatic) were included in the study. The weighted means of FACT-Br subscale and overall scores were calculated for the studies. To compare these scores, weighted analysis of variance was conducted and PROC GLM was performed for the data. A P-value of < 0.05 was considered statistically significant. RESULTS A total of 23 studies (four in brain metastases, 18 in primary brain tumors and 1 in a mixed sample) using the FACT-Br for assessment of QOL were identified. Social and functional well-being were significantly better in patients with primary brain tumors (weighted mean score of 22.2 vs. 10.7, P = 0.0026, 16.9 vs. 6.2, P = 0.0025, respectively). No other scale of the FACT-Br was significantly different between the two groups and the performance status of patients included in both groups was similar. CONCLUSION Patients with primary brain cancer seemed to have better social and functional well-being scores than those with metastatic brain tumors. Other QOL domains were similar between these two groups. However, the heterogeneity in the included studies and the low sample size of included samples in patients with metastatic brain tumors could have confounded our findings.
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Affiliation(s)
- Nicholas Chiu
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Leonard Chiu
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Liang Zeng
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Liying Zhang
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marko Popovic
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ronald Chow
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Henry Lam
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael Poon
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Ducray F. Chemotherapy for diffuse low-grade gliomas in adults. Rev Neurol (Paris) 2011; 167:673-9. [DOI: 10.1016/j.neurol.2011.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Revised: 08/02/2011] [Accepted: 08/03/2011] [Indexed: 10/17/2022]
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Blonski M, Taillandier L, Herbet G, Maldonado IL, Beauchesne P, Fabbro M, Campello C, Gozé C, Rigau V, Moritz-Gasser S, Kerr C, Rudà R, Soffietti R, Bauchet L, Duffau H. Combination of neoadjuvant chemotherapy followed by surgical resection as a new strategy for WHO grade II gliomas: a study of cognitive status and quality of life. J Neurooncol 2011; 106:353-66. [PMID: 21785913 DOI: 10.1007/s11060-011-0670-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 07/13/2011] [Indexed: 11/26/2022]
Abstract
Diffuse WHO grade II (GIIG) may be unresectable when involving critical structures. To assess the feasibility and functional tolerance (cognition and quality of life) of an original therapeutic strategy combining neoadjuvant chemotherapy followed by surgical resection for initially inoperable GIIG. Ten patients underwent Temozolomide for unresectable GIIG, as initial treatment or at recurrence after previous partial resection, due to invasion of eloquent areas or bi-hemispheric diffusion preventing a total/subtotal removal. Functional outcome after both treatments was assessed, with evaluation of seven cognitive domains. Chemotherapy induced tumor shrinkage (median volume decrease 38.9%) in ipsilateral functional areas in six patients and in the contralateral hemisphere in four. Only four patients had a 1p19q codeletion. The tumor shrinkage made possible the resection (mean extent of resection 93.3%, 9 total or subtotal removals) of initially inoperable tumors. Postoperatively, three patients had no deficits, while verbal episodic memory and executive functions were slightly impaired in seven patients. However, global quality of life was roughly preserved on the EORTC QLQ C30 + BN 20 (median score: 66.7%). Role functioning score was relatively reduced (median score: 66.7%) whereas KPS was preserved (median score: 90, range 80-100). Seven patients became seizure-free while three improved. This combined treatment is feasible, efficient (surgery made possible by neoadjuvant chemotherapy) and well-tolerated (preservation of quality of life, no serious cognitive disturbances). Cognitive deficits seem mostly related to tumor location. Because KPS is not reliable enough, a detailed neuropsychological assessment should be systematically performed in GIIG.
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Affiliation(s)
- Marie Blonski
- Division of Neuro-Oncology, Department of Neurology, Nancy University Hospital, Nancy, France
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Using different schedules of Temozolomide to treat low grade gliomas: systematic review of their efficacy and toxicity. J Neurooncol 2011; 105:135-47. [DOI: 10.1007/s11060-011-0657-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 06/24/2011] [Indexed: 10/18/2022]
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Jakola AS, Unsgård G, Solheim O. Quality of life in patients with intracranial gliomas: the impact of modern image-guided surgery. J Neurosurg 2011; 114:1622-30. [DOI: 10.3171/2011.1.jns101657] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Outcome following brain tumor operations is often assessed by health professionals using various gross function scales. However, surprisingly little is known about how modern glioma surgery affects quality of life (QOL) as reported by the patients themselves. In the present study the authors aimed to assess changes in QOL after glioma surgery, to explore the relationship between QOL and traditional outcome parameters, and to examine possible predictors of change in QOL.
Methods
Eighty-eight patients with glioma were recruited from among those 16 years or older who had been admitted to the authors' department for brain tumor surgery in the period between January 2007 and December 2009. A 3D ultrasonography–based navigation system was utilized in nearly all operations and functional MR imaging data on eloquent lesions were incorporated into the neuronavigation system. Preoperative scores for QOL (EuroQol 5D [EQ-5D]) and functional status (Karnofsky Performance Scale [KPS]) were obtained. The EQ-5D and KPS scores were subsequently recorded 6 weeks postoperatively, as were responses to a structured interview about new deficits and possible complications.
Results
There was no change in the median EQ-5D indexes following surgery, 0.76 versus 0.75 (p = 0.419). The EQ-5D index value was significantly correlated with the KPS score (p < 0.001; rho = 0.769). The EQ-5D index values and KPS scores improved in 35.2% and 24.1% of cases, were equal in 20.5% and 47.2% of cases, and deteriorated in 44.3% and 28.7%, respectively. Thus, both improvement and deterioration were underestimated by the KPS score as compared with the patient-reported QOL assessment. New motor deficits (p = 0.003), new language deficits (p = 0.035), new unsteadiness and/or ataxia (p = 0.001), occipital lesions (p = 0.019), and no use of ultrasonography for resection control (p = 0.021) were independent predictors of worsening QOL in a multivariate model.
Conclusions
The surgical procedures per se may not significantly alter QOL in the average patient with glioma; however, new deficits have a major undesirable effect on QOL. It seems that the active use of intraoperative ultrasonography may be associated with a preservation of QOL. The EQ-5D seems like a good outcome measure with a strong correlation to traditional variables while offering a more detailed description of outcome.
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Affiliation(s)
- Asgeir S. Jakola
- 1Department of Neurosurgery
- 4Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geirmund Unsgård
- 1Department of Neurosurgery
- 2Departments of Neuroscience and
- 3National Centre for 3D Ultrasound in Surgery, St. Olavs University Hospital; and
| | - Ole Solheim
- 1Department of Neurosurgery
- 2Departments of Neuroscience and
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Cheng JX, Liu BL, Zhang X, Zhang YQ, Lin W, Wang R, Zhang YQ, Zhang HY, Xie L, Huo JL. The validation of the standard Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30) in pre-operative patients with brain tumor in China. BMC Med Res Methodol 2011; 11:56. [PMID: 21513533 PMCID: PMC3112193 DOI: 10.1186/1471-2288-11-56] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 04/22/2011] [Indexed: 11/12/2022] Open
Abstract
Background Health related quality of life (HRQOL) has increasingly emphasized on cancer patients. The psychometric properties of the standard Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30, version 3.0) in brain tumor patients wasn't proven, and there was no baseline HRQOL in brain tumor patients prior to surgery. Methods The questionnaire EORTC QLQ-C30 (version 3.0) was administered at three time points: T1, the first or the second day that patients were hospitalized after the brain tumor suspected or diagnosed by MRI or CT; T2, 1 to 2 days after T1, (T1 and T2 were both before surgery); T3, the day before discharge. Clinical variables included disease histologic types, cognitive function, and Karnofsky Performance Status. Results Cronbach's alpha coefficients for multi-item scales were greater than .70 and multitrait scaling analysis showed that most of the item-scale correlation coefficients met the standards of convergent and discriminant validity, except for the cognitive functioning scale. All scales and items exhibited construct validity. Score changes over peri-operation were observed in physical and role functioning scales. Compared with mixed cancer patients assessed after surgery but before adjuvant treatment, brain tumor patients assessed pre-surgery presented better function and fewer symptoms. Conclusions The standard Chinese version of the EORTC QLQ-C30 was overall a valid instrument to assess HRQOL in brain tumor patients in China. The baseline HRQOL in brain tumor patients pre-surgery was better than that in mixed cancer patients post-surgery. Future study should modify cognitive functioning scale and examine test-retest reliability and response validity.
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Affiliation(s)
- Jin-xiang Cheng
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, People's Republic of China
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48
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Abstract
The optimal management of patients with low-grade glioma (LGG) is controversial. The controversy largely stems from the lack of well-designed clinical trials with adequate follow-up to account for the relatively long progression-free survival and overall survival of patients with LGG. Nonetheless, the literature increasingly suggests that expectant management is no longer optimal. Rather, there is mounting evidence supporting active management including consideration of surgical resection, radiotherapy, chemotherapy, molecular and histopathologic characterization, and use of modern imaging techniques for monitoring and prognostication. In particular, there is growing evidence favoring extensive surgical resection and increasing interest in the role of chemotherapy (especially temozolomide) in the management of these tumors. In this review, we critically analyze emerging trends in the literature with respect to management of LGG, with particular emphasis on reports published during the past year.
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Taphoorn MJB, Sizoo EM, Bottomley A. Review on quality of life issues in patients with primary brain tumors. Oncologist 2010; 15:618-26. [PMID: 20507891 DOI: 10.1634/theoncologist.2009-0291] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Health-related quality of life (HRQOL) has become an important outcome measure in clinical trials in primary brain tumor (i.e., glioma) patients, because they have an incurable disease. HRQOL is assessed using self-reported, validated questionnaires, addressing physical, psychological, emotional, and social issues. In addition to generic HRQOL instruments, disease-specific questionnaires have been developed, including for brain tumor patients. For the analysis and interpretation of HRQOL measurements, low compliance and missing data are methodological challenges. HRQOL in glioma patients may be negatively affected by the disease itself as well as by side effects of treatment. But treatment with surgery, radiotherapy, and chemotherapy may improve patient functioning and HRQOL, in addition to extending survival. Although HRQOL has prognostic significance in brain tumor patients, it is not superior to well-known clinical parameters, such as age and performance status. In clinical practice, assessing HRQOL may be helpful in the communication between doctor and patient and may facilitate treatment decisions.
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Affiliation(s)
- Martin J B Taphoorn
- VU University Medical Center, Department of Neurology, Amsterdam, The Netherlands.
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García M, Clopés A, Bruna J, Martínez M, Fort E, Gil M. Critical appraisal of temozolomide formulations in the treatment of primary brain tumors: patient considerations. Cancer Manag Res 2009; 1:137-50. [PMID: 21188132 PMCID: PMC3004664 DOI: 10.2147/cmr.s5598] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Indexed: 01/13/2023] Open
Abstract
Chemotherapy is assuming an increasingly important role in the treatment of malignant gliomas, of which temozolomide (TMZ) is a key part. TMZ belongs to a class of second-generation imidazotetrazinone prodrugs that exhibit linear pharmacokinetics and do not require hepatic metabolism for activation to the active metabolite. New intravenous (iv) TMZ formulations have recently been approved based on studies of bioequivalence between iv and oral TMZ. The efficacy of TMZ was initially evaluated in patients with recurrent disease but phase II and III trials in newly diagnosed gliomas are available. The results of a large phase III trial that compared RT alone vs RT concomitant with oral TMZ created a new standard of adjuvant treatment. Efficacy data for iv TMZ on which its approval was based are those extrapolated from clinical trials with oral TMZ. No comparative data are available on the differences in tolerability and patient satisfaction between oral and iv formulations of TMZ, or for quality of life. New oral formulations could encourage the adherence of patients to treatment. Although patients presumably would prefer oral treatment, iv formulations may be an alternative in noncompliant patients or patients for whom good adherence could not be expected.
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Affiliation(s)
- Margarita García
- Clinical Research Unit, Institut Català d'Oncologia-IDIBELL, L'Hospitalet, Barcelona, Spain
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