title: Therapy for Recurrent High-Grade Gliomas: Results of a Prospective Multicenter Study on Health-Related Quality of Life.
abstract: OBJECTIVE
  To assess the impact of therapy on patients' health-related quality of life (HRQoL) in recurrent high-grade glioma (HGG) in an unselected cohort.
  
  
  METHODS
  In this prospective multicenter study, we analyzed European Organization for Research and Treatment of Cancer Quality of Life core questionnaire and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Brain Neoplasm module questionnaires of 92 patients within 1 year after diagnosis of tumor recurrence of a HGG and respective treatment. We evaluated the influence of re-radiation, second- and third-line chemotherapies, and number of recurrent surgeries on summary scores for functioning, symptoms, and total score as well as on subscores for functioning and neurologic symptoms using multivariate mixed models and descriptive statistics.
  
  
  RESULTS
  After we adjusted for Karnofsky Performance Score and age, different recurrent therapies did not significantly impact HRQoL. Neither re-radiation nor recurrent surgery significantly influenced HRQoL (total score, P = 0.66; P = 0.64). Patients receiving second-line chemotherapy showed moderately better physical and role functioning as well as less motor dysfunction than patients receiving third-line chemotherapy. When we compared HRQoL after second-line chemotherapies, patients receiving intensified temozolomide dosages demonstrated a moderately better outcome for cognitive functioning and less communication deficits (P = 0.055) than patients treated with bevacizumab. Regarding number of recurrent surgeries, we found stable HRQoL scores until second recurrent surgery, whereas after third recurrent surgery HRQoL decreased.
  
  
  CONCLUSIONS
  Our results from an unselected cohort of recurrent HGGs show that the currently available treatment options have no negative impact on HRQoL. Thus, treatment decisions can be made individually, without fear of jeopardizing HRQoL for better survival. Only, the third recurrent surgery remains a very individual decision even in younger patients with high Karnofsky Performance Score.
authors.affiliation: Department of Neurosurgery, University of Ulm, Günzburg, Germany.
authors.forename: Linda
authors.initials: L
authors.lastname: Stöckelmaier
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 of Ulm, Günzburg, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Nickel
authors.affiliation: Center for Endoscopic and Minimally Invasive Neurosurgery, Clinic Hierslanden, Zürich, Switzerland.
authors.forename: Anne-Katrin
authors.initials: AK
authors.lastname: Hickmann
authors.affiliation: Department of Internal Medicine III, Ulm University, Ulm, Germany.
authors.forename: Regine
authors.initials: R
authors.lastname: Mayer-Steinacker
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, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Ganslandt
authors.affiliation: Department of Internal Medicine III, Ulm University, Ulm, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Bullinger
authors.affiliation: Department of Neurosurgery, University of Ulm, Günzburg, Germany.
authors.forename: Christian Rainer
authors.initials: CR
authors.lastname: Wirtz
authors.affiliation: Department of Neurosurgery, University of Ulm, Günzburg, Germany. Electronic address: jan.coburger@uni-ulm.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Coburger
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D005910:Glioma / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000523:psychology* / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D018714:Radiotherapy, Adjuvant; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Health-related quality of life; High-grade glioma; KPS; Re-radiation; Recurrence therapy; Recurrent surgery