Phase I/II Trial of 5-Fraction Stereotactic Radiosurgery with 5-mm Margins with Concurrent and Adjuvant Temozolomide in Newly Diagnosed Supratentorial Glioblastoma: Health Related Quality of Life Results

Publication date: Available online 7 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Erqi L. Pollom, Dylann Fujimoto, Jacob Wynne, Kira Seiger, Leslie A. Modlin, Lisa R. Jacobs, Melissa Azoulay, Rie von Eyben, Laurie Tupper, Iris C. Gibbs, Steven L. Hancock, Gordon Li, Steven D. Chang, John R. Adler, Griffith R. Harsh, Ciara Harraher, Seema Nagpal, Reena P. Thomas, Lawrence D. Recht, Clara Y.H. Choi, Scott G. Soltys
PurposeWe report a longitudinal assessment of health-related quality of life (HRQOL) in patients with glioblastoma (GBM) treated on a prospective dose escalation trial of 5-fraction stereotactic radiosurgery (25-40 Gy in 5 fractions) with concurrent and adjuvant temozolomide.MethodsHRQOL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire core-30 (QLQ-C30) general, the EORTC quality of life questionnaire-brain cancer specific module (QLQ-BN20), and the M.D. Anderson Symptom Inventory–Brain Tumor (MDASI-BT). Questionnaires were completed at baseline and at every follow-up after completion of radiosurgery. Changes from baseline for nine predefined HRQOL measures (global quality of life, physical functioning, social functioning, emotional functioning, motor dysfunction, communication deficit, fatigue, insomnia and future uncertainty) were calculated at every time point.ResultsWith a median follow-up of 10.4 months (range 0.4-52 months), 139 total HRQOL questionnaires were completed by the 30 patients on trial. Compliance with HRQOL assessment was 76% at 12 months. Communication deficit significantly worsened over time, with a decline of 1.7 points per month (p=0.008). There were no significant changes over time detected in the other 8 scales of our primary analysis, including global quality of life. Although 8 patients (27%) developed adverse radiation effect (ARE) on this dose escalation trial, it was not associated with a statistically significant decline in any of the primary HRQOL scales. Disease progression was associated with communication deficit, with patients experiencing an average worsening of 13.9 points per month after progression compared to 0.7 points per month prior to progression (p=0.01).ConclusionOn this 5-fraction dose escalation protocol for newly diagnosed GBM, overall HRQOL remained stable and appears similar to historical controls of 30 fractions of radiotherapy. Tumor recurrence was associated with worsening communication deficit, while ARE did not correlate with a decline in HRQOL.



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