title: The patients' view: impact of the extent of resection, intraoperative imaging, and awake surgery on health-related quality of life in high-grade glioma patients-results of a multicenter cross-sectional study.
abstract: The objective of the present study is to assess the influence of extent of resection (EoR), use of intraoperative imaging, and awake surgery on health-related quality of life (HRQoL) in high-grade glioma (HGG) patients in a prospective multicenter study. We analyzed 170 surgeries of patients suffering from a HGG. During the first year after resection, HRQoL was evaluated using the European Organization of Research and Treatment of Cancer Core Questionnaire C30 and Brain Neoplasm 20 questionnaires. We assessed the influence of EoR; awake surgery; and use of 5-aminolevulinic acid (5-ALA), intraoperative MRI (iMRI), and their combination on sum scores for function and symptoms as well as several neurological single items. In mixed-model analyses, adjustments for age, Karnofsky performance status (KPS), and eloquent location were performed. In the mixed model, EoR generally did not significantly influence HRQoL (p = 0.10). Yet, patients receiving subtotal resection (STR) vs. patients with biopsy showed significantly better QoL and role and cognitive functions (p = 0.04, p = 0.02, and p < 0.01, respectively). The combination of iMRI and 5-ALA reached the highest EoR (95%) followed by iMRI alone (94%), 5-ALA alone (74%), and no imaging (73%). Thereby, neurological symptoms were lowest and functioning score highest after combined use of iMRI and 5-ALA, without reaching significance (p = 0.59). Despite lower scores in emotional function (59 vs. 46, p = 0.24), no significant impact of awake surgery on HRQoL was found (p = 0.70). In HGG patients, STR compared to biopsy was significantly associated with better HRQoL and fewer neurological symptoms in this series. An escalated use of intraoperative imaging increased EoR with stable or slightly better HRQoL and fewer neurological symptoms. Based on HRQoL, awake surgery was a well-tolerated and safe method in our series.
authors.affiliation: Department of Neurosurgery, University Ulm, Günzburg, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Nickel
authors.affiliation: Department of Neurosurgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Renovanz
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Jochem
authors.initials: J
authors.lastname: König
authors.affiliation: Department of Neurosurgery, University Ulm, Günzburg, Germany.
authors.forename: Linda
authors.initials: L
authors.lastname: Stöckelmaier
authors.affiliation: Center for Endoscopic and Minimally Invasive Neurosurgery, Klinik Hierslanden, Zürich, Switzerland.
authors.forename: Anne-Katrin
authors.initials: AK
authors.lastname: Hickmann
authors.affiliation: Department of Neurosurgery, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany.
authors.forename: Minou
authors.initials: M
authors.lastname: Nadji-Ohl
authors.affiliation: Department of Neurosurgery, University Ulm, Günzburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Engelke
authors.affiliation: Department of Neurosurgery, Klinikum Ludwigsburg, Ludwigsburg, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Weimann
authors.affiliation: Department of Neurosurgery, Klinikum Ludwigsburg, Ludwigsburg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Freudenstein
authors.affiliation: Department of Neurosurgery, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Ganslandt
authors.affiliation: Department of Internal Medicine III, University Ulm, Ulm, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Bullinger
authors.affiliation: Department of Neurosurgery, University Ulm, Günzburg, Germany.
authors.forename: Christian Rainer
authors.initials: CR
authors.lastname: Wirtz
authors.affiliation: Department of Neurosurgery, University Ulm, Günzburg, Germany. Jan.coburger@uni-ulm.de.
authors.forename: Jan
authors.identifier: http://orcid.org/0000-0002-3677-8258
authors.initials: J
authors.lastname: Coburger
mesh_terms: D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000627:therapeutic use; D001706:Biopsy; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D003071:Cognition; D003430:Cross-Sectional Studies; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D063868:Patient Outcome Assessment; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014851:Wakefulness
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid
keywords: 5-Aminolevulinic acid; Awake surgery; Extent of resection; Health-related quality of life; High-grade glioma; Intraoperative magnetic resonance imaging; Karnofsky performance status