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J Neurooncol. 2009 Nov;95(2):247-257. doi: 10.1007/s11060-009-9923-3. Epub 2009 Jun 16.

Health related quality of life and cognitive status in patients with glioblastoma multiforme receiving escalating doses of conformal three dimensional radiation on RTOG 98-03.

Author information

1
Tel Aviv Medical Center, 6 Weizman Street, Tel Aviv, 64239, Israel. bencorn@tasmc.health.gov.il.
2
Statistical Unit, RTOG, 1800 Market Street, Philadelphia, PA, USA.
3
Cullather Brain Tumor QOL Center Bonsecours Richmond, 4349 Collingswood Dr, Chesterfield, VA, 23832, USA.
4
Washington University Medical Center, 4921 Parkview Pl Campus Box 8224, St. Louis, MO, 63110, USA.
5
UC Davis Medical Center, 4501 X St Ste G140, Sacramento, CA, 95817, USA.
6
Washington University in St. Louis, 4921 Parkview Pl Campus Box 8224, St. Louis, MO, 63110-1001, USA.
7
Arizona Oncology Services, 350 W Thomas Rd, Phoenix, AZ, 85013, USA.
8
Emory University School of Medicine, 1365 Clifton Rd, NE Atlanta, GA, 30322, USA.
9
Cancer Therapy and Research Center, 7703 Floyd Curl Dr MSC 7889, San Antonio, TX, 78229, USA.
10
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave K4 312-3685, Madison, WI, 53792, USA.
11
Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA.

Abstract

The Radiation Therapy Oncology Group (RTOG) embarked on a phase I/II study of patients suffering from glioblastoma multiforme (protocol 98-03) to assess the impact of dose escalation with 3-D conformal techniques. The primary endpoints were feasibility and survival. This report describes the outcome of secondary endpoints (quality of life and neurocognitive function). Patients with supratentorial GBM were treated with a combination of carmustine (BCNU) and conformal irradiation (dose levels: 66, 72, 78, 84 Gy, respectively). Quality of Life was assessed with the Spitzer Quality of Life Index. Neurocognitive function was determined by the Mini Mental Status Examination. The latter tests were administered at the start of irradiation, at the end of irradiation and then at 4 month intervals. Relatively high compliance was achieved with both of the tools (SQLI; MMSE). Overall rates of survival between baseline SQLI scores <7 and 7-10 were statistically significantly different [HR = 1.72, 95% CI (1.22, 2.4), P = 0.0015]. The significant impact of high SQLI score on survival was preserved in multivariate analysis. The component of this index which made the greatest contribution was the patient's independence. There was continual deterioration of neurocognitive function within the populations studied. No correlation was seen between dose escalation and the secondary endpoints studied. Radiation dose escalation and assessment of its impact on life quality and neurocognition can be carried out in a large international trial. Baseline SQLI is a statistically significant determinant of survival. Those who maintain independence have superior survival to those who are reliant on others.

PMID:
19533025
PMCID:
PMC2864919
DOI:
10.1007/s11060-009-9923-3
[Indexed for MEDLINE]
Free PMC Article

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