Health related quality of life and cognitive status in patients with glioblastoma multiforme receiving escalating doses of conformal three dimensional radiation on RTOG 98-03.
The Radiation Therapy Oncology Group (RTOG) embarked on a phase I/II study of patients suffering from glioblastoma multiforme (protocol 98-03) to assess the impact of dose escalation with 3-D conformal techniques. The primary endpoints were feasibility and survival. This report describes the outcome of secondary endpoints (quality of life and neurocognitive function). Patients with supratentorial GBM were treated with a combination of carmustine (BCNU) and conformal irradiation (dose levels: 66, 72, 78, 84 Gy, respectively). Quality of Life was assessed with the Spitzer Quality of Life Index. Neurocognitive function was determined by the Mini Mental Status Examination. The latter tests were administered at the start of irradiation, at the end of irradiation and then at 4 month intervals. Relatively high compliance was achieved with both of the tools (SQLI; MMSE). Overall rates of survival between baseline SQLI scores <7 and 7-10 were statistically significantly different [HR = 1.72, 95% CI (1.22, 2.4), P = 0.0015]. The significant impact of high SQLI score on survival was preserved in multivariate analysis. The component of this index which made the greatest contribution was the patient's independence. There was continual deterioration of neurocognitive function within the populations studied. No correlation was seen between dose escalation and the secondary endpoints studied. Radiation dose escalation and assessment of its impact on life quality and neurocognition can be carried out in a large international trial. Baseline SQLI is a statistically significant determinant of survival. Those who maintain independence have superior survival to those who are reliant on others.
Corn
Benjamin W
BW
Tel Aviv Medical Center, 6 Weizman Street, Tel Aviv, 64239, Israel. bencorn@tasmc.health.gov.il.
Wang
Meihua
M
Statistical Unit, RTOG, 1800 Market Street, Philadelphia, PA, USA.
Fox
Sherry
S
Cullather Brain Tumor QOL Center Bonsecours Richmond, 4349 Collingswood Dr, Chesterfield, VA, 23832, USA.
Michalski
Jeffrey
J
Washington University Medical Center, 4921 Parkview Pl Campus Box 8224, St. Louis, MO, 63110, USA.
Purdy
James
J
UC Davis Medical Center, 4501 X St Ste G140, Sacramento, CA, 95817, USA.
Simpson
Joseph
J
Washington University in St. Louis, 4921 Parkview Pl Campus Box 8224, St. Louis, MO, 63110-1001, USA.
Kresl
John
J
Arizona Oncology Services, 350 W Thomas Rd, Phoenix, AZ, 85013, USA.
Curran
Walter J
WJ
Emory University School of Medicine, 1365 Clifton Rd, NE Atlanta, GA, 30322, USA.
Diaz
Aidnag
A
Cancer Therapy and Research Center, 7703 Floyd Curl Dr MSC 7889, San Antonio, TX, 78229, USA.
Mehta
Minesh
M
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave K4 312-3685, Madison, WI, 53792, USA.
Movsas
Benjamin
B
Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002330:Carmustine / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011379:Prognosis; D011788:Quality of Life; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal; D015996:Survival Rate; D055815:Young Adult
D018906:Antineoplastic Agents, Alkylating; D002330:Carmustine