Current medical research and opinion · 2013
Effects of surgical resection on the evolution of quality of life in newly diagnosed patients with glioblastoma: a report on 19 patients surviving to follow-up.
Клиническое исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Daigle Kathya, Fortin David, Mathieu David, Saint-Pierre Arnaud B, Paré François-Michel, de la Sablonnière Annie, Goffaux Philippe
Аннотация
OBJECTIVE: Although aggressive tumor resection favors survival in neuro-oncology, its effects on quality of life (QOL) are largely unspecified. The objective of the present study, therefore, was to study the relationship between tumor resection and QOL.
METHODS: We conducted a longitudinal study among 35 patients presenting with a suspected, and later confirmed, glioblastoma multiforme tumor. Following surgery, all patients received radiation therapy with concomitant temozolomide. Tumor volumes were segmented manually, and extent of resection was calculated by comparing pre- and post-operative volumes. QOL was obtained at intake and 3 months later, using the Sherbrooke Neuro-Oncology Assessment Scale. Change in QOL was determined by computing the difference between intake and follow-up data. Confounds were controlled for by detrending change in QOL scores from the effects of age, initial tumor volume, tumor location, and baseline QOL.
RESULTS: Results showed that larger tumors at intake provoke increased pain (mostly headaches; r = 0.41, p = 0.015) and decreased social support/acceptance of disease (r = 0.43, p = 0.009). Results also showed that compared to biopsies, craniotomies were associated with preserved well-being across nearly all domains of QOL. When extent of resection was analyzed more specifically, results confirmed that larger resections prevented the decay in functional well-being (r = 0.616, p = 0.005) and neurocognitive function (r = 0.51, p = 0.026) typically observed as time progresses. Larger resections were also independently associated with prolonged survival.
CONCLUSIONS: Although the data were obtained from a relatively small sample of patients, results indicate that aggressive resections avert decay in QOL, and thus prolong optimized survival.
METHODS: We conducted a longitudinal study among 35 patients presenting with a suspected, and later confirmed, glioblastoma multiforme tumor. Following surgery, all patients received radiation therapy with concomitant temozolomide. Tumor volumes were segmented manually, and extent of resection was calculated by comparing pre- and post-operative volumes. QOL was obtained at intake and 3 months later, using the Sherbrooke Neuro-Oncology Assessment Scale. Change in QOL was determined by computing the difference between intake and follow-up data. Confounds were controlled for by detrending change in QOL scores from the effects of age, initial tumor volume, tumor location, and baseline QOL.
RESULTS: Results showed that larger tumors at intake provoke increased pain (mostly headaches; r = 0.41, p = 0.015) and decreased social support/acceptance of disease (r = 0.43, p = 0.009). Results also showed that compared to biopsies, craniotomies were associated with preserved well-being across nearly all domains of QOL. When extent of resection was analyzed more specifically, results confirmed that larger resections prevented the decay in functional well-being (r = 0.616, p = 0.005) and neurocognitive function (r = 0.51, p = 0.026) typically observed as time progresses. Larger resections were also independently associated with prolonged survival.
CONCLUSIONS: Although the data were obtained from a relatively small sample of patients, results indicate that aggressive resections avert decay in QOL, and thus prolong optimized survival.