Skip to main content
SpringerLink
Log in

Quality of life following concurrent temozolomide-based chemoradiation therapy or observation in low-grade glioma

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Low-grade glioma (LGG) exhibits longer median survival than high-grade brain tumors, and thus impact of our therapies on patient quality of life remains a crucial consideration. This study evaluated the effects of concurrent temozolomide-based chemoradiation (RT + TMZ) or observation on quality of life (QOL) in patients with low-grade glioma.

Methods

We completed a retrospective cross-sectional study of adults with LGG who underwent surgery with known molecular classification from 1980 to 2018. Postoperatively, patients were either observed or received adjuvant concurrent temozolomide-based chemoradiation. EQ-5D and PHQ-9 depression screen were completed before outpatient visits every 2–3 months. Baseline score was defined as ± 30 days within initial operation.

Results

Of the 63 patients (mean age 44 ± 17 years, 51% female) with baseline EQ-5D or PHQ-9 depression screen data and at least one follow-up measure, 30 (48%) were observed and 33 (52%) received RT + TMZ. No significant decline was seen in EQ-5D or PHQ-9 scores at 3, 6, 9, 12, and 24 months compared to baseline scores for all patients. At each time point, there was no significant difference between those who were observed or received adjuvant therapy. The linear mixed model estimating PHQ-9 value or EQ-5D index demonstrated that there was no significant difference in PHQ-9 or EQ-5D index between treatment groups (p = 0.42 and p = 0.54, respectively) or time points (p = 0.24 and p = 0.99, respectively).

Conclusion

Our study found no significant decline in patient QOL or depression scores as assessed by patient- reported outcome measures for patients with low-grade glioma up to 2 years following surgery. We found no difference between RT + TMZ compared to observation during this time frame. Additional follow-up can help identify the longer-term impact of treatment strategy on patient experience.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

Research data are stored in an institutional repository and will be shared upon request to the corresponding author.

References

  1. Claus E, Black P (2006) Survival rates and patterns of care for patients diagnosed with supratentorial low-grade gliomas: data from the SEER program, 1973–2001. Cancer 106:1358–1363. https://doi.org/10.1002/cncr.21733

    Article  PubMed  Google Scholar 

  2. Murphy ES, Leyrer CM, Parsons M et al (2018) Risk factors for malignant transformation of low-grade glioma. Int J Radiat Oncol Biol Phys 100:965–971. https://doi.org/10.1016/j.ijrobp.2017.12.258

    Article  PubMed  Google Scholar 

  3. Tom MC, Park DY, Yang K et al (2019) Malignant transformation of molecularly classified adult low-grade glioma. Int J Radiat Oncol Biol Phys 105:1106–1112

    Article  Google Scholar 

  4. van den Bent MJ, Afra D, de Witte O et al (2005) Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet Lond Engl 366:985–990. https://doi.org/10.1016/S0140-6736(05)67070-5

    Article  Google Scholar 

  5. Pignatti F, van den Bent M, Curran D et al (2002) Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol 20:2076–2084. https://doi.org/10.1200/JCO.2002.08.121

    Article  PubMed  Google Scholar 

  6. Olson JD, Riedel E, DeAngelis LM (2000) Long-term outcome of low-grade oligodendroglioma and mixed glioma. Neurology 54:1442–1448. https://doi.org/10.1212/WNL.54.7.1442

    Article  CAS  Google Scholar 

  7. McGirt MJ, Chaichana KL, Attenello FJ et al (2008) Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery 63:700–707; author reply 707–708. https://doi.org/10.1227/01.NEU.0000325729.41085.73

  8. Smith JS, Chang EF, Lamborn KR et al (2008) Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol Off J Am Soc Clin Oncol 26:1338–1345. https://doi.org/10.1200/JCO.2007.13.9337

    Article  Google Scholar 

  9. Reijneveld JC, Taphoorn MJB, Coens C et al (2016) Health-related quality of life in patients with high-risk low-grade glioma (EORTC 22033–26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol 17:1533–1542. https://doi.org/10.1016/S1470-2045(16)30305-9

    Article  PubMed  Google Scholar 

  10. Aaronson NK, Taphoorn MJB, Heimans JJ et al (2011) Compromised health-related quality of life in patients with low-grade glioma. J Clin Oncol Off J Am Soc Clin Oncol 29:4430–4435. https://doi.org/10.1200/JCO.2011.35.5750

    Article  Google Scholar 

  11. Gustafsson M, Edvardsson T, Ahlström G (2006) The relationship between function, quality of life and coping in patients with low-grade gliomas. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 14:1205–1212. https://doi.org/10.1007/s00520-006-0080-3

    Article  Google Scholar 

  12. Klein M, Engelberts NHJ, van der Ploeg HM et al (2003) Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life. Ann Neurol 54:514–520. https://doi.org/10.1002/ana.10712

    Article  PubMed  Google Scholar 

  13. Laack NN, Brown PD, Ivnik RJ et al (2005) Cognitive function after radiotherapy for supratentorial low-grade glioma: a North Central Cancer Treatment Group prospective study. Int J Radiat Oncol Biol Phys 63:1175–1183. https://doi.org/10.1016/j.ijrobp.2005.04.016

    Article  PubMed  Google Scholar 

  14. Klein M, Heimans J, Aaronson N et al (2002) Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study. The Lancet 360:1361–1368. https://doi.org/10.1016/S0140-6736(02)11398-5

    Article  CAS  Google Scholar 

  15. Bell EH, Zhang P, Shaw EG et al (2020) Comprehensive genomic analysis in NRG oncology/RTOG 9802: a phase III trial of radiation versus radiation plus procarbazine, lomustine (CCNU), and vincristine in high-risk low-grade glioma. J Clin Oncol Off J Am Soc Clin Oncol 38:3407–3417. https://doi.org/10.1200/JCO.19.02983

    Article  CAS  Google Scholar 

  16. Jaeckle KA, Ballman KV, van den Bent M et al (2021) CODEL: phase III study of RT, RT + TMZ, or TMZ for newly diagnosed 1p/19q codeleted oligodendroglioma. Analysis from the initial study design. Neuro-Oncol 23:457–467. https://doi.org/10.1093/neuonc/noaa168

    Article  PubMed  Google Scholar 

  17. van den Bent MJ, Tesileanu CMS, Wick W et al (2021) Adjuvant and concurrent temozolomide for 1p/19q non-co-deleted anaplastic glioma (CATNON; EORTC study 26053–22054): second interim analysis of a randomised, open-label, phase 3 study. Lancet Oncol 22:813–823. https://doi.org/10.1016/S1470-2045(21)00090-5

    Article  PubMed  Google Scholar 

  18. Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996. https://doi.org/10.1056/NEJMoa043330

    Article  CAS  PubMed  Google Scholar 

  19. Shaw JW, Johnson JA, Coons SJ (2005) US valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med Care 43:203–220

    Article  Google Scholar 

  20. Greiner W, Weijnen T, Nieuwenhuizen M et al (2003) A single European currency for EQ-5D health states. Eur J Health Econ Former HEPAC 4:222–231. https://doi.org/10.1007/s10198-003-0182-5

    Article  Google Scholar 

  21. Pickard AS, Wilke CT, Lin H-W, Lloyd A (2007) Health utilities using the EQ-5D in studies of cancer. Pharmacoeconomics 25:365–384. https://doi.org/10.2165/00019053-200725050-00002

    Article  PubMed  Google Scholar 

  22. Pickard AS, Ray S, Ganguli A, Cella D (2012) Comparison of FACT- and EQ-5D–based utility scores in cancer. Value Health 15:305–311. https://doi.org/10.1016/j.jval.2011.11.029

    Article  PubMed  Google Scholar 

  23. Hays RD, Bjorner JB, Revicki DA et al (2009) Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 18:873–880. https://doi.org/10.1007/s11136-009-9496-9

    Article  Google Scholar 

  24. Thompson NR, Lapin BR, Katzan IL (2017) Mapping PROMIS global health items to EuroQol (EQ-5D) utility scores using linear and equipercentile equating. Pharmacoeconomics 35:1167–1176. https://doi.org/10.1007/s40273-017-0541-1

    Article  PubMed  Google Scholar 

  25. Pickard AS, Neary MP, Cella D (2007) Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer. Health Qual Life Outcomes 5:70. https://doi.org/10.1186/1477-7525-5-70

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kvam AK, Fayers PM, Wisloff F (2011) Responsiveness and minimal important score differences in quality-of-life questionnaires: a comparison of the EORTC QLQ-C30 cancer-specific questionnaire to the generic utility questionnaires EQ-5D and 15D in patients with multiple myeloma. Eur J Haematol 87:330–337. https://doi.org/10.1111/j.1600-0609.2011.01665.x

    Article  PubMed  Google Scholar 

  27. Arroll B, Goodyear-Smith F, Crengle S et al (2010) Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med 8:348–353. https://doi.org/10.1370/afm.1139

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gilbody S, Richards D, Barkham M (2007) Diagnosing depression in primary care using self-completed instruments: UK validation of PHQ-9 and CORE-OM. Br J Gen Pract J R Coll Gen Pract 57:650–652

    Google Scholar 

  29. Spitzer RL, Kroenke K, Williams JBW, and the Patient Health Questionnaire Primary Care Study Group (1999) Validation and utility of a self-report version of PRIME-MDThe PHQ primary care study. JAMA 282:1737–1744. https://doi.org/10.1001/jama.282.18.1737

    Article  Google Scholar 

  30. Thekkumpurath P, Walker J, Butcher I et al (2011) Screening for major depression in cancer outpatients: the diagnostic accuracy of the 9-item patient health questionnaire. Cancer 117:218–227. https://doi.org/10.1002/cncr.25514

    Article  PubMed  Google Scholar 

  31. Johns SA, Kroenke K, Krebs EE et al (2013) Longitudinal comparison of three depression measures in adult cancer patients. J Pain Symptom Manag 45:71–82. https://doi.org/10.1016/j.jpainsymman.2011.12.284

    Article  Google Scholar 

  32. Randall JM, Voth R, Burnett E et al (2013) Clinic-based depression screening in lung cancer patients using the PHQ-2 and PHQ-9 depression questionnaires: a pilot study. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 21:1503–1507. https://doi.org/10.1007/s00520-012-1712-4

    Article  Google Scholar 

  33. Wang M, Cairncross G, Shaw E et al (2010) Cognition and quality of life after chemotherapy plus radiotherapy (RT) vs. RT for pure and mixed anaplastic oligodendrogliomas: radiation therapy oncology group trial 9402. Int J Radiat Oncol Biol Phys 77:662–669

    Article  Google Scholar 

  34. Taphoorn MJ, van den Bent MJ, Mauer ME et al (2007) Health-related quality of life in patients treated for anaplastic oligodendroglioma with adjuvant chemotherapy: results of a European Organisation for Research and Treatment of Cancer randomized clinical trial. J Clin Oncol 25:5723–5730

    Article  Google Scholar 

  35. Taphoorn MJB, Stupp R, Coens C et al (2005) Health-related quality of life in patients with glioblastoma: a randomised controlled trial. Lancet Oncol 6:937–944. https://doi.org/10.1016/S1470-2045(05)70432-0

    Article  PubMed  Google Scholar 

  36. Reddy K, Gaspar LE, Kavanagh BD et al (2013) Prospective evaluation of health-related quality of life in patients with glioblastoma multiforme treated on a phase II trial of hypofractionated IMRT with temozolomide. J Neurooncol 114:111–116. https://doi.org/10.1007/s11060-013-1159-6

    Article  CAS  PubMed  Google Scholar 

  37. Minniti G, Scaringi C, Baldoni A et al (2013) Health-related quality of life in elderly patients with newly diagnosed glioblastoma treated with short-course radiation therapy plus concomitant and adjuvant temozolomide. Int J Radiat Oncol Biol Phys 86:285–291. https://doi.org/10.1016/j.ijrobp.2013.02.013

    Article  PubMed  Google Scholar 

  38. Perry JR, Laperriere N, O’Callaghan CJ et al (2017) Short-course radiation plus temozolomide in elderly patients with glioblastoma. N Engl J Med 376:1027–1037. https://doi.org/10.1056/NEJMoa1611977

    Article  CAS  PubMed  Google Scholar 

  39. Wefel J, Pugh S, Choucair A et al (2019) NCOG-01. Neurocognitive function (NCF) and quality of life (QOL) results from a phase II study of temozolomide-based chemoradiotherapy regimen for high risk low-grade gliomas. Neuro-Oncology 21:vi158–vi159. https://doi.org/10.1093/neuonc/noz175.663

  40. Fisher BJ, Pugh SL, Macdonald DR et al (2020) Phase 2 study of a temozolomide-based chemoradiation therapy regimen for high-risk, low-grade gliomas: long-term results of Radiation Therapy Oncology Group 0424. Int J Radiat Oncol Biol Phys 107:720–725. https://doi.org/10.1016/j.ijrobp.2020.03.027

    Article  PubMed  PubMed Central  Google Scholar 

  41. Vigliani MC, Sichez N, Poisson M, Delattre JY (1996) A prospective study of cognitive functions following conventional radiotherapy for supratentorial gliomas in young adults: 4-year results. Int J Radiat Oncol Biol Phys 35:527–533. https://doi.org/10.1016/s0360-3016(96)80015-0

    Article  CAS  PubMed  Google Scholar 

  42. Armstrong CL, Hunter JV, Ledakis GE et al (2002) Late cognitive and radiographic changes related to radiotherapy: initial prospective findings. Neurology 59:40–48. https://doi.org/10.1212/WNL.59.1.40

    Article  CAS  PubMed  Google Scholar 

  43. Torres IJ, Mundt AJ, Sweeney PJ et al (2003) A longitudinal neuropsychological study of partial brain radiation in adults with brain tumors. Neurology 60:1113–1118. https://doi.org/10.1212/01.wnl.0000055862.20003.4a

    Article  CAS  PubMed  Google Scholar 

  44. Glosser G, McManus P, Munzenrider J et al (1997) Neuropsychological function in adults after high dose fractionated radiation therapy of skull base tumors. Int J Radiat Oncol Biol Phys 38:231–239. https://doi.org/10.1016/s0360-3016(97)00099-0

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The authors did not receive funds, grants, or other support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA

    Deborah Y. Park, Surabhi Tewari, Jennifer S. Yu, Samuel T. Chao, John H. Suh, David Peereboom, Glen H. J. Stevens, Gene H. Barnett, Lilyana Angelov, Alireza M. Mohammadi, Richard Naugle & Erin S. Murphy

  2. Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA

    Martin C. Tom & Manmeet S. Ahluwalia

  3. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue / CA-60, Cleveland, OH, 44195, USA

    Wei Wei & Brittany Lapin

  4. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue / CA-50, Cleveland, OH, 44195, USA

    Jennifer S. Yu, Samuel T. Chao, John H. Suh & Erin S. Murphy

  5. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center and Neurological institute, Cleveland Clinic, Cleveland, OH, USA

    Samuel T. Chao, John H. Suh, David Peereboom, Glen H. J. Stevens, Gene H. Barnett, Lilyana Angelov, Alireza M. Mohammadi & Erin S. Murphy

  6. Department of Neuropsychology, Cleveland Clinic, Cleveland, OH, USA

    Thomas Hogan, Courtney Kissel & Richard Naugle

  7. Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA

    Isabel Schuermeyer

  8. Neuro-Oncology Center and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Michael W. Parsons

  9. Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA

    Gene H. Barnett, Lilyana Angelov & Alireza M. Mohammadi

Authors
  1. Deborah Y. Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin C. Tom
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Surabhi Tewari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manmeet S. Ahluwalia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jennifer S. Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Samuel T. Chao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. John H. Suh
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. David Peereboom
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Glen H. J. Stevens
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Gene H. Barnett
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Lilyana Angelov
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Alireza M. Mohammadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Thomas Hogan
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Courtney Kissel
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Brittany Lapin
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Isabel Schuermeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Michael W. Parsons
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Richard Naugle
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Erin S. Murphy
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by WW, DP, and EM. The first draft of the manuscript was written by DP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Erin S. Murphy.

Ethics declarations

Conflict of interest

Gene H. Barnett has received speaker and consultant honoraria from Monteris Medical. Martin C. Tom has received consultant honoraria from Viewray Inc and institutional research funding from Blue Earth Diagnostics Ltd. John H. Suh received consultant honoraria from Novocure, Philips, and Neutron Therapeutics. Samuel T. Chao received consultant honoraria to Varain Medical Systems, Manmeet S. Ahluwalia was given grants from Astrazeneca, BMS, Bayer, Incyte, Pharmacyclics, Novocure, Mimivax, Merck as well as consultant honoraria from Bayer, Novocure, Kiyatec, Insightec, GSK, Xoft, Nuvation, Cellularity, SDP Oncology, Apollomics, Prelude, Janssen, Forma therapeutics, Astrazeneca, Karyopharm, BMS, Tocagen, Abbvie, VBI Vaccines, Flatiron, Bayer, Varian Medical Systems, Voyager therapeutics. Manmeet S. Ahluwalia owns stocks in Doctible, Mimivax, Cytodyn, MedInnovate Advisors LLC. The other authors have no financial or proprietary interests in any material discussed in this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, D.Y., Tom, M.C., Wei, W. et al. Quality of life following concurrent temozolomide-based chemoradiation therapy or observation in low-grade glioma. J Neurooncol 156, 499–507 (2022). https://doi.org/10.1007/s11060-021-03920-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-021-03920-6

Keywords

Search

Navigation