title: Perioperative quality of life in functionally dependent glioblastoma patients: A prospective study.
abstract: OBJECTIVE
  Functionally dependent patients with glioblastoma have a poor prognosis which may in part be due to a negative treatment selection. Prospective data on patient-reported quality of life (QoL) following surgery, together with an updated survival analysis, are lacking with regard to functionally dependent glioblastoma patients.
  
  
  METHODS
  Adult patients (≥ 18 years) with a histologically confirmed primary glioblastoma with preoperative Karnofsky Performance Status (KPS) ≤ 60, who were treated between January 1, 2007 and March 30, 2014, were eligible for inclusion. EuroQol 5D (EQ-5D) was scored before surgery and at 4-6 weeks postoperatively. A control group of 20 independent (i.e., KPS ≥ 70) adult primary glioblastoma patients was constructed.
  
  
  RESULTS
  Among the 27 patients included, only 22 patients were willing to participate in QoL research, with complete QoL follow-up data obtained for 16. There were 22 resections and 5 biopsies. In resection cases, the median extent of resection was 93% (IQR 78-99), with gross-total resection achieved in 24%. In the 16 patients with complete QoL data, the EQ-5D index score increased from 0.34 ± 0.38 preoperatively to 0.45 ± 0.32 postoperatively (p = 0.30), with 3 patients that deteriorated in QoL following surgery. Median survival was 7.3 months (95%, CI: 4.6-9.9, n = 27), and the perioperative mortality was 7%. Treatment characteristics between dependent and independent patients were similar, as were the unfavorable outcomes defined as QoL reduction, QoL drop-out, and dead before QoL assessment (41% vs. 45%, p = 0.79). However, a difference was seen in 6-month survival (42% vs. 15%, p = 0.05).
  
  
  CONCLUSIONS
  In most functionally dependent patients with glioblastoma, cytoreductive surgery is possible, and improved or unchanged postoperative QoL may be seen in approximately half of the cases. This must be weighed against the risk of complications and the modest effect of cytoreductive surgery.
authors.affiliation: a Department of Neurosurgery , St. Olavs University Hospital , Trondheim , Norway.|b Norwegian Advisory Unit for Ultrasound and Image-Guided Surgery, St. Olavs University Hospital , Trondheim , Norway.|c Department of Neurosurgery , Sahlgrenska University Hospital , Gothenburg , Sweden.
authors.forename: Asgeir S
authors.initials: AS
authors.lastname: Jakola
authors.affiliation: a Department of Neurosurgery , St. Olavs University Hospital , Trondheim , Norway.|b Norwegian Advisory Unit for Ultrasound and Image-Guided Surgery, St. Olavs University Hospital , Trondheim , Norway.|e Department of Neuroscience , Norwegian University of Science and Technology , Trondheim , Norway.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Sagberg
authors.affiliation: a Department of Neurosurgery , St. Olavs University Hospital , Trondheim , Norway.|d Norwegian Centre of Competence in Deep Brain Stimulation for Movement Disorders, St. Olavs University Hospital , Trondheim , Norway.
authors.forename: Sasha
authors.initials: S
authors.lastname: Gulati
authors.affiliation: a Department of Neurosurgery , St. Olavs University Hospital , Trondheim , Norway.|b Norwegian Advisory Unit for Ultrasound and Image-Guided Surgery, St. Olavs University Hospital , Trondheim , Norway.|e Department of Neuroscience , Norwegian University of Science and Technology , Trondheim , Norway.
authors.forename: Ole
authors.initials: O
authors.lastname: Solheim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001932:Brain Neoplasms / Q000523:psychology* / Q000601:surgery*; D005260:Female; D005909:Glioblastoma / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period / Q000401:mortality / Q000523:psychology*; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: brain neoplasm; complications; glioblastoma; surgical management