title: Surgical strategies in low-grade gliomas and implications for long-term quality of life.
abstract: Reports on long-term health related quality of life (HRQL) after surgery for World Health Organization grade II diffuse low-grade gliomas (LGG) are rare. We aimed to compare long-term HRQL in two hospital cohorts with different surgical strategies. Biopsy and watchful waiting was favored in one hospital, while early resections guided with three-dimensional (3D) ultrasound was favored in the other. With a population-based approach 153 patients with histologically verified LGG treated from 1998-2009 were included. Patients still alive were contacted for HRQL assessment (n=91) using generic (EQ-5D; EuroQol Group, Rotterdam, The Netherlands) and disease specific (EORTC QLQ-C30 and BN20; EORTC Quality of Life Department, Brussels, Belgium) questionnaires. Results on HRQL were available in 79 patients (87%), 25 from the hospital that favored biopsy and 54 from the hospital that favored early resection. Among living patients there was no difference in EQ-5D index scores (p=0.426). When imputing scores defined as death (zero) in patients dead at follow-up, a clinically relevant difference in EQ-5D score was observed in favor of early resections (p=0.022, mean difference 0.16, 95% confidence interval 0.02-0.29). In EORTC questionnaires pain, depression and concern about disruption in family life were more common with a strategy of initial biopsy only (p=0.043, p=0.032 and p=0.045 respectively). In long-term survivors an aggressive surgical approach using intraoperative 3D ultrasound image guidance in LGG does not lower HRQL compared to a more conservative surgical approach. This finding further weakens a possible role for watchful waiting in LGG.
authors.affiliation: Department of Neurosurgery, St. Olav's University Hospital, N-7006 Trondheim, Norway; MI Lab, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; National Centre for Ultrasound and Image Guided Therapy, Trondheim, Norway. Electronic address: asgeir.s.jakola@ntnu.no.
authors.forename: Asgeir S
authors.initials: AS
authors.lastname: Jakola
authors.affiliation: Department of Neurosurgery, St. Olav's University Hospital, N-7006 Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; National Centre for Ultrasound and Image Guided Therapy, Trondheim, Norway.
authors.forename: Geirmund
authors.initials: G
authors.lastname: Unsgård
authors.affiliation: Department of Pathology, University Hospital of Northern Norway, Tromsø, Norway.
authors.forename: Kristin S
authors.initials: KS
authors.lastname: Myrmel
authors.affiliation: Department of Ophthalmology and Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway.
authors.forename: Roar
authors.initials: R
authors.lastname: Kloster
authors.affiliation: Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Sverre H
authors.initials: SH
authors.lastname: Torp
authors.affiliation: National Centre for Ultrasound and Image Guided Therapy, Trondheim, Norway.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Sagberg
authors.affiliation: Department of Pathology, University Hospital of Northern Norway, Tromsø, Norway.
authors.forename: Sigurd
authors.initials: S
authors.lastname: Lindal
authors.affiliation: Department of Neurosurgery, St. Olav's University Hospital, N-7006 Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; National Centre for Ultrasound and Image Guided Therapy, Trondheim, Norway.
authors.forename: Ole
authors.initials: O
authors.lastname: Solheim
mesh_terms: D000328:Adult; D001706:Biopsy; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D060787:Neoplasm Grading; D011788:Quality of Life; D025321:Surgery, Computer-Assisted / Q000379:methods; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods; D057832:Watchful Waiting
keywords: Low-grade glioma; Neurosurgery; Quality of life; Treatment; Ultrasound