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Evolution of the Karnosky Performance Status throughout life in glioblastoma patients

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Abstract

Functional independence in glioblastoma (GBM) patients is a key factor in measuring the quality of life. Progression free survival (PFS) and overall survival (OS) have been largely described. However, the evolution over time of the performance status during the patients’ life remains understudied. We thus studied the time to loss of functional independence as assessed by a Karnosky Performance Status (KPS) below 70 % in GBM patients. We analysed all GBM patients treated in our institution between 2008 and 2013 and meeting the following criteria: age >18 years, supratentorial location, post-surgical KPS ≥ 70 %, initially treated with concomitant radiotherapy (RT) and Temozolomide. Within the 84 patients studied, the median PFS was 9 months and the median OS was 18.7 months. The median survival time with functional independence (KPS ≥ 70 %) was 14.5 months. On average, the patients spent 73 % of their lifespan with a KPS ≥ 70 %. Surgical resection and low steroid dosage were statistically associated with increased survival time with KPS ≥ 70 % (p = 0.015 and p = 0.03, respectively). Sixty-two (62) patients received one or several lines of chemotherapy at recurrence. Under treatment with Bevacizumab (42 Bev-based regimens), radiological responses were seen in 35 % and improvement in KPS occurred in 24 % whereas no response and rare improvement of KPS (3 %) were seen with other type of chemotherapy (97 non Bev-based regimens). In GBM patients, median survival with KPS ≥ 70 % largely exceeds PFS. Surgical resection and low steroids dosage at RT-onset appeared as good prognosis factors for survival with functional independence.

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References

  1. Davis ME, Stoiber AM (2011) Glioblastoma multiforme: enhancing survival and quality of life. Clin J Oncol Nurs 15:291–297

    Article  PubMed  Google Scholar 

  2. Behin A, Hoang-Xuan K, Carpentier AF, Delattre JY (2003) Primary brain tumours in adults. Lancet 361:323–331

    Article  PubMed  Google Scholar 

  3. Mauer M, Stupp R, Taphoorn MJ, Coens C, Osoba D, Marosi C, Wong R, de Witte O, Cairncross JG, Efficace F, Mirimanoff RO, Forsyth P, Van Den Bent MJ, Weller M, Bottomley A (2007) The prognostic value of health-related quality-of-life data in predicting survival in glioblastoma cancer patients: results from an international randomised phase III EORTC Brain Tumour and Radiation Oncology Groups and NCIC Clinical Trials Group study. Br J Cancer 97:302–307

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO, European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996

    Article  CAS  PubMed  Google Scholar 

  5. Stark AM, Stepper W, Mehdorn HM (2010) Outcome evaluation in glioblastoma patients using different ranking scores: KPS, GOS, mRS and MRC. Eur J Cancer Care 19:39–44

    Article  CAS  Google Scholar 

  6. Buccheri G, Ferrigno D, Tamburini M (2006) Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer 32:1135–1141

    Article  Google Scholar 

  7. Sulter G, Steen C, De Keyser J (1999) Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke 30:1538–1541

    Article  CAS  PubMed  Google Scholar 

  8. Chinot OL, Wick W, Mason W, Henriksson R, Saran F, Nishikawa R, Carpentier AF, Hoang-Xuan K, Kavan P, Cernea D, Brandes AA, Hilton M, Abrey L, Cloughesy T (2014) Bevacizumab plus radiotherapy-temozolomide for newly diagnosed glioblastoma. N Engl J Med 370:709–722

    Article  CAS  PubMed  Google Scholar 

  9. Gilbert MR, Dignam JJ, Armstrong TS, Wefel JS, Blumenthal DT, Vogelbaum MA, Colman H, Chakravarti A, Pugh S, Won M, Jeraj R, Brown PD, Jaeckle KA, Schiff D, Stieber VW, Brachman DG, Werner-Wasik M, Tremont-Lukats IW, Sulman EP, Aldape KD, Curran WJ, Mehta MP (2014) A randomized trial of bevacizumab for newly diagnosed glioblastoma. N Engl J Med 370:699–708

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Taal W, Oosterkamp HM, Walenkamp AM, Dubbink HJ, Beerepoot LV, Hanse MC, Buter J, Honkoop AH, Boerman D, de Vos FY, Dinjens WN, Enting RH, Taphoorn MJ, van den Berkmortel FW, Jansen RL, Brandsma D, Bromberg JE, van Heuvel I, Vernhout RM, van der Holt B, van den Bent MJ (2014) Single-agent bevacizumab or lomustine versus a combination of bevacizumab plus lomustine in patients with recurrent glioblastoma (BELOB trial): a randomised controlled phase 2 trial. Lancet Oncol 15:943–953

    Article  CAS  PubMed  Google Scholar 

  11. Li J, Wang M, Won M, Shaw EG, Coughlin C, Curran WJ, Mehta MP (2011) Validation and simplification of the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) classification for glioblastoma (GBM). Int J Radiat Oncol Biol Phys 81:623–630

    Article  PubMed Central  PubMed  Google Scholar 

  12. Wen PY, Macdonald DR, Reardon DA et al (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28:1963–1972

    Article  PubMed  Google Scholar 

  13. Chambless LB, Kistka HM, Parker SL, Hassam-Malani L, McGirt MJ, Thompson RC (2015) The relative value of postoperative versus preoperative Karnofsky Performance Scale scores as a predictor of survival after surgical resection of glioblastoma multiforme. J Neurooncol 121:359–364

    Article  PubMed  Google Scholar 

  14. Hempen C, Weiss E, Hess CF (2002) Dexamethasone treatment in patients with brain metastases and primary brain tumors: do the benefits outweigh the side-effects? Support Care Cancer 10:322–328

    Article  PubMed  Google Scholar 

  15. Bussiere M, Hopman W, Day A, Pombo AP, Neves T, Espinosa F (2005) Indicators of functional status for primary malignant brain tumour patients. Can J Neurol Sci 32:50–56

    Article  PubMed  Google Scholar 

  16. Recht L, Glantz M, Chamberlain M, Hsieh CC (2003) Quantitative measurement of quality outcome in malignant glioma patients using an independent living score (ILS). Assessment of a retrospective cohort. J Neurooncol 61:127–136

    Article  CAS  PubMed  Google Scholar 

  17. Chaichana KL, Halthore AN, Parker SL, Olivi A, Weingart JD, Brem H, Quinones-Hinojosa A (2011) Factors involved in maintaining prolonged functional independence following supratentorial glioblastoma resection. J Neurosurg 114:604–612

    Article  PubMed Central  PubMed  Google Scholar 

  18. Gil-Gil MJ, Mesia C, Rey M, Bruna J (2013) Bevacizumab for the treatment of glioblastoma. Clin Med Insights Oncol 7:123–135

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Hofer S, Elandt K, Greil R, Hottinger AF, Huber U, Lemke D, Marosi C, Ochsenbein A, Pichler J, Roelcke U, Weder P, Zander T, Wick W, Weller M (2011) Clinical outcome with bevacizumab in patients with recurrent high-grade glioma treated outside clinical trials. Acta Oncol 50:630–635

    Article  CAS  PubMed  Google Scholar 

  20. Tabouret E, Barrie M, Thiebaut A, Matta M, Boucard C, Autran D, Loundou A, Chinot O (2013) Limited impact of prognostic factors in patients with recurrent glioblastoma multiforme treated with a bevacizumab-based regimen. J Neurooncol 114:191–198

    Article  CAS  PubMed  Google Scholar 

  21. Vredenburgh JJ, Cloughesy T, Samant M, Prados M, Wen PY, Mikkelsen T, Schiff D, Abrey LE, Yung WK, Paleologos N, Nicholas MK, Jensen R, Das A, Friedman HS (2010) Corticosteroid use in patients with glioblastoma at first or second relapse treated with bevacizumab in the BRAIN study. Oncologist 15:1329–1334

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the Association Oligocyte, the Association pour le développement des neurosciences à Avicenne (ADNA) and the Assistance Publique-Hôpitaux de Paris (AP/HP).

Conflict of interest

Antoine Carpentier is consultant for Roche.

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Authors and Affiliations

  1. Service de Neurologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, 125 route de Stalingrad, 93009, Bobigny, France

    Adama Sacko, Miao-Miao Hou, Michael Temgoua, Ali Alkhafaji, Athina Marantidou, Catherine Belin, Renata Ursu, Jennifer Doridam, Irène Coman & Antoine F. Carpentier

  2. Médecine et Biologie Humaine, UFR de Santé, Université Paris 13, 93009, Bobigny, France

    Athina Marantidou, Jennifer Doridam & Antoine F. Carpentier

  3. Service de Neurochirurgie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Paris, France

    Emmanuel Mandonnet

  4. Université Paris 7, Paris, France

    Emmanuel Mandonnet

  5. Institut de Radiothérapie des Hautes Energies (IRHE), 93009, Bobigny, France

    Christine Levy-Piedbois

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  1. Adama Sacko
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  2. Miao-Miao Hou
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  3. Michael Temgoua
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  4. Ali Alkhafaji
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  5. Athina Marantidou
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  6. Catherine Belin
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  7. Emmanuel Mandonnet
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  8. Renata Ursu
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  9. Jennifer Doridam
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  10. Irène Coman
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  11. Christine Levy-Piedbois
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  12. Antoine F. Carpentier
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Corresponding author

Correspondence to Antoine F. Carpentier.

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Sacko, A., Hou, MM., Temgoua, M. et al. Evolution of the Karnosky Performance Status throughout life in glioblastoma patients. J Neurooncol 122, 567–573 (2015). https://doi.org/10.1007/s11060-015-1749-6

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  • DOI: https://doi.org/10.1007/s11060-015-1749-6

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