gms | German Medical Science

Objective: Despite extensive therapy, gliomas and brain metastases have a great impact on personal and social life, e.g., due to the physical, emotional and cognitive decline. As a result, life expectancy may be limited profoundly. Physical deficits such as motor impairments diminish personal autonomy and quality of life. However, not only tumor localization and size but also tumor histology and social factors may significantly influence the health-related quality of life (HRQL) in patients. Thus, we prospectively assessed HRQL in patients with metastases and brain tumors located in eloquent areas.

Method: To date, 38 patients with tumors located in the eloquent area adjacent to the central region underwent HRQL assessment prior to surgery (GBM n=20, LGG n=3, oligoastrocytoma n=1, metastasis n=8, lymphoma n=1, anaplastic ependymoma n=1, meningioma n=3). In n=14 patients HRQL was evaluated 3±2 months after surgery. The neurological status was assessed at admission and within 12 hours postoperatively. Assessment of HRQL was gained by means of standardized EORTC and SF-12 questionnaires to evaluate e.g. physical and social functioning, role limitations, cognitive impairment. We compared the pre- and postoperative neurological status and HRQL for differences between tumor entity, sex and further influencing factors.

Results: All patients experienced moderate deficits in the overall health status but a distinct reduction of role and social functioning leading to impairment of the General Health Status (GHS) preoperatively. Females felt more constrained in emotional and cognitive functioning (p<0.05) but showed better role and social functioning as well as better GHS (p<0.05). Patients with glioblastoma (GBM) had a reduced GHS but less limitation in role, social and emotional functioning compared to LGG patients (p<0.05). The comparison of tumor entity showed a trend towards significantly better physical, social and emotional functioning in GBM patients compared to brain metastases patients as well as a higher GHS (p<0.1).Pre- and postoperative comparison of HRQL in 12 GBM patients showed no significant difference.

Conclusions: All patients with brain tumors adjacent to the primary motor cortex have a reduced GHS preoperatively. Glioma malignancy had a negative influence on the quality of life, whereas brain metastases lead to a marked reduction of HRQL when compared to GBM patients. The impact of surgery on the HRQL is under investigation since a larger subset of patients is required to meet sufficient statistical power.