Article
Safety and efficacy of patients with high grade glioma treated with D,L-Methadone
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Authors
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Christian von der Brelie
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Bernd Alt-Epping
- Georg-August-Universität Göttingen, Palliativmedizin, Göttingen, Deutschland
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Bawarjan Schatlo
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Ingo Fiss
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Christoph Bettag
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Michael Metz
- Georg-August-Universität Göttingen, Joint Practice for Hematology and Oncology, Göttingen, Deutschland
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Veit Rohde
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Annalen Bleckmann
- Georg-August-Universität Göttingen, Hämatologie und Onkologie, Göttingen, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: D,L-Methadone has played a role in palliative care and is used for pain treatment in patients with cancer. Recently an increasing number of articles and TV programmes in (social) media suggested that D,L-Methadone would positively influence the clinical course of patients with high grad glioma so that patients understandably ask for prescription of D,L-Methadone. Scientifically, the clinical use of D,L-Methadone is not supported by substantial data. Further, administration of D,L-Methadone might harbor serious side effects especially in neuro-oncological patients. The aim of this study is to evaluate the safety and efficacy of the treatment with D,L-Methadone intake with special emphasis on side effects.
Methods: Patients with high grade astrocytoma (WHO grade 3 and 4) were included in this retrospective observational analysis. All patients received D,L-Methadone, no matter if they were treated for initial tumor diagnosis or recurrent disease. Patients were assigned to have a complication due to the use of D,L-Methadone if the medical condition changed in an appropriate timely fashion after the start of the intake of D,L-Methadone and if the symptoms resolved after cessation of D,L-Methadone. Complications were only assigned if medical intervention was needed. Overall survival of the patients with D,L-Methadone was compared with a matched cohort (regarding age, histology, extent of resection, IDH-1 and MGMT status).
Results: 19 patients were included. All patients were opioid-naïve and received D,L-Methadone from palliative caregivers or clinical oncologists. 11 patients had complications. Mean daily dosage leading to complication was 8 mg. Most frequent complications were fatigue and depressant symptoms (10 of 11 patients). 4 patients had severe complications (one patient suffered from a fall due to a syncope; two patients were admitted to the hospital in a comatose condition; one patient was admitted to the hospital due to a severe psychotic episode). In all cases, symptoms resolved after cessation and/or reduction of D,L-Methadone. Overall survival was not different compared to a matched cohort.
Conclusion: In our experience intake of D,L-Methadone in glioma patients frequently lead to complications which significantly impaired the quality of life. These observations should be used to counsel patients who seek for D,L-Methadone prescription.
