gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Quality of life in primary and recurrent glioblastoma patients: The impact of resection and adjuvant treatment, a single centre prospective study

Meeting Abstract

  • M. Rapp - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf
  • Y. Kriese - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf
  • M. Göppert - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf
  • W. Stummer - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf
  • H.-J. Steiger - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf
  • M. Sabel - Klinik für Neurochirurgie, Heinrich-Heine-Universität Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.10-01

DOI: 10.3205/09dgnc240, URN: urn:nbn:de:0183-09dgnc2402

Published: May 20, 2009

© 2009 Rapp et al.
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Outline

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Objective: Treatment for glioblastoma (GBM) patients has become more effective due to alkylating chemotherapy (both local and systemic) and maximal resection, resulting in an increase in overall survival. Evaluations of these concepts have mainly focused on survival parameters and toxicity. We performed a prospective longitudinal health-related quality of life (HRQOL) observation study, including all primary GBM patients treated in our institution since 2006.

Methods: At present 71 patients were included. Regarding the extent of resection, patients were divided into partial (PR, n=35) and near complete (<5 ml residual tumor; NCR, n=36). All patients were treated according to the Stupp-scheme. Upon recurrence, 29 patients were treated with re-resection, implantation of a Gliadel wafer and subsequent intensified TMZ (one week on/off, group A). 21 patients were treated with TMZ (5/23, group B). After tumor re-recurrence, patients were treated with irinotecan and bevacizumab (group C, n=12). HRQOL was evaluated by completion of EORTC–C30-BCM20, Zung depression scale (SDS) and the Karnofsky performance scale (KPS) preoperatively, postoperatively, before and after each new treatment regimen as well as every three months.

Results: Until recurrence no significant deterioration of HRQOL was detectable. At all times NCR patients presented with a significant higher KPS than PR (p=0.03) patients. Post-op patients <60 y revealed a significantly better functional scale (p=0.04), less visual disorders (p=0.02) and lower symptom scale (p=0.04) as compared to patients >60y.

Upon recurrence, patients in group A showed a decline of global health (p=0.06) and of functional scale (p=0.01). In group A, post-op patients >60y presented significantly more motor dysfunction (p=0.04) than younger patients. There was a significant decrease of KPS during therapy (p=0.001, p=0.01, respectively) in both group A and B patients.

Surprisingly, patients in group C demonstrated a trend towards increased global health, a significant increase of functional scales (p=0.03) and a trend towards decreased future uncertainty.

Conclusions: The primary treatment of GBM patients, including near complete surgical resection and intensive adjuvant therapy does not decrease the HRQOL. Despite different treatment schemes during tumor recurrence,a therapy-associated decline in HRQOL and KPS seems to be unavoidable. Interestingly, patients in group C benefit from therapy regarding HRQOL.