Worsening of quality of life (QoL), cognitive functions (CF) and psychological status (PSY) can predict radiologic progressive disease (RPD) in glioblastoma (GBM) patients (PTS) treated with radiation therapy (RT) and temozolomide (TMZ): a mono-institutional prospective study

Background

Almost all PTS with GBM treated with RT and TMZ relapse during or after treatment. We performed a prospective study to assess if deterioration of QoL, CF and PSY is a predictor of RPD.

Methods

PTS with newly histologically diagnosed GBM treated with RT and TMZ as first-line therapy and KPS>60 were enrolled. PTS received TMZ for 12 cycles or until unacceptable toxicity or progressive disease. All questionnaires were given to PTS for self-assessment before performing MRI. Macdonald criteria were used for radiological evaluation. We assessed QoL, CF and PSY before starting treatment, at the end of RT, and every 3 months until 9 months after the end of RT using EORTC-C30, BN-20, MMSE and HADS questionnaires. Brain MRI were performed at the same timepoints.

Results

We prospectively enrolled 111 consecutive PTS at our oncological center, Veneto Institute of Oncology, between January 2013 and December 2015. Median age was 59; 69 PTS were male and 36 PTS aged ≥65. PTS showing a RPD reported lower physical functioning (p = 0.018), minor role function (p = 0.0007) and a lower global health status (p = 0.01) than patients without RPD. In addition, they reported greater uncertainty in the future (p = 0.007), increased drowsiness (p = 0.013), increased itchy skin (p = 0.005) and greater weakness in the legs (p = 0.027) compared to PTS without RPD. PTS with RPD were more anxious (p = 0.0021) and depressed (p = 0.0001) than PTS without RPD. The two groups significantly differed in CF (p = 0.0007), especially 1 and 6 months after RT, with worse results in the MMSE for PTS with RPD.

Conclusions

Worsening of QoL, CF and PSY can predict RPD in GBM PTS treated with RT and TMZ.

Clinical trial identification

Legal entity responsible for the study

Veneto Institute of Oncology

Funding

None

Disclosure

All authors have declared no conflicts of interest.