Changes in functional performance measures in adults undergoing chemoradiation for primary malignant glioma: a feasibility study.
OBJECTIVE
To investigate the feasibility of longitudinal assessment of functional performance measures in newly diagnosed postsurgical malignant glioma patients.


METHODS
Patients with histologically confirmed, clinically stable, postsurgical, and previously untreated high-grade glioma (HGG) or low-grade glioma (LGG) were studied. Using a prospective design, all participants performed a cardiopulmonary exercise test with expired gas analysis to assess cardiorespiratory function (VO(2peak)) immediately following surgical resection (mean, 10 days). Additional functional outcomes were skeletal muscle cross-sectional area (CSA) via magnetic resonance imaging, isokinetic muscle strength (isokinetic dynamometry), and body composition (air displacement plethysmography). Quality of life (QOL) was assessed by the Functional Assessment of Cancer Therapy-Brain scale. All study assessments were repeated at 6 and 24 weeks following surgery.


RESULTS
Thirty-five patients (HGG, n = 25; LGG, n = 10) completed baseline assessments. Of these, 20 HGG (80%) and nine LGG (90%) and 15 HGG (60%) and nine LGG (90%) patients completed study assessments at 6 weeks and 24 weeks, respectively. Intention-to-treat analyses indicated several significant time-by-group interactions, with favorable improvements in functional and QOL endpoints from baseline to 24 weeks in the LGG cohort and unfavorable changes in the HGG cohort. Per-protocol analyses including participants assessed at all three study timepoints indicated significant improvements in VO(2peak) and fatigue from baseline to 24 weeks in the HGG cohort; peak workload, body composition, and muscle strength improved from baseline to 6 weeks (all p-values < .05).


CONCLUSIONS
Longitudinal quantitative functional assessments are safe and feasible among select patients undergoing chemoradiation for primary malignant glioma. Large prospective studies investigating the clinical importance of these measures appear warranted.
Jones
Lee W
LW
Duke University Medical Center, Durham, North Carolina 27710, USA. lee.w.jones@duke.edu
Mourtzakis
Marina
M
Peters
Katherine B
KB
Friedman
Allan H
AH
West
Miranda J
MJ
Mabe
Stephanie K
SK
Kraus
William E
WE
Friedman
Henry S
HS
Reardon
David A
DA
D000328:Adult; D001932:Brain Neoplasms / Q000188:drug therapy / Q000503:physiopathology* / Q000532:radiotherapy / Q000628:therapy*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005910:Glioma / Q000188:drug therapy / Q000503:physiopathology* / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D011446:Prospective Studies; D011788:Quality of Life