Skip to main content
Top
Published in: Journal of Cancer Research and Clinical Oncology 6/2020

01-06-2020 | Glioblastoma | Original Article – Clinical Oncology

Proton therapy re-irradiation preserves health-related quality of life in large recurrent glioblastoma

Authors: Daniele Scartoni, Dante Amelio, Pierpaolo Palumbo, Irene Giacomelli, Maurizio Amichetti

Published in: Journal of Cancer Research and Clinical Oncology | Issue 6/2020

Login to get access

Abstract

Purpose

Proton therapy could minimize the risk of side effects and, therefore, reduce the possible detrimental effect on health-related quality of life (HRQOL) of re-irradiation. The aim of this study was to determine the effect of re-irradiation with active scanning proton therapy on recurrent glioblastoma (GBM) in terms of HRQOL scored by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30 and EORTC Quality of Life Questionnaire Brain Cancer Module (QLQ-BN20).

Methods

Thirty-three patients with recurrent GBM were re-irradiated with active scanning proton therapy. Subscales within the EORTC QLQ-C30 include five functional scales, six single-item scales, and global QoL. The BN20 assessed visual disorders, motor function, communication deficit, various disease symptoms, treatment, toxicity, and future uncertainty. The patients completed the questionnaires before starting proton therapy, the last day of proton therapy, and at every follow-up visit until progression of disease.

Results

The treatment was associated with improvement or stability in most of the preselected HRQOL domains. Global health improved over time with a maximum difference of six points between baseline and 3-months follow-up. Social functioning and motor dysfunction improved over time with a maximum difference of eight and two points, respectively. We showed a non-significant decrease in cognitive and emotional functioning. Fatigue remained stable during the analysis such as the other preselected domains.

Conclusions

Re-irradiation with proton therapy is a safe and effective treatment in patients with recurrent glioblastoma. Proton therapy does not negatively effect on HRQOL, but rather it seems to preserve HRQOL until the time of disease progression.
Literature
go back to reference Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRef Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRef
go back to reference Amelio D, Amichetti M (2012) Radiation therapy for the treatment of recurrent glioblastoma: an overview. Cancers (Basel) 4(1):257–280CrossRef Amelio D, Amichetti M (2012) Radiation therapy for the treatment of recurrent glioblastoma: an overview. Cancers (Basel) 4(1):257–280CrossRef
go back to reference Aprile I, Chiesa S, Padua L (2015) Occurrence and predictors of the fatigue in high-grade glioma patients. Neurol Sci 36:1363–1369CrossRef Aprile I, Chiesa S, Padua L (2015) Occurrence and predictors of the fatigue in high-grade glioma patients. Neurol Sci 36:1363–1369CrossRef
go back to reference Bitterlich C, Vordermark D (2017) Analysis of health-related quality of life in patients with brain tumors prior and subsequent to radiotherapy. Oncol Lett 14(2):1841–1846CrossRef Bitterlich C, Vordermark D (2017) Analysis of health-related quality of life in patients with brain tumors prior and subsequent to radiotherapy. Oncol Lett 14(2):1841–1846CrossRef
go back to reference Central Brain Tumor Registry of the United States (CBTRUS) (2010) Statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2004–2007. https://www.cbtrus.org. Accessed 20 Mar 2020 Central Brain Tumor Registry of the United States (CBTRUS) (2010) Statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2004–2007. https://​www.​cbtrus.​org. Accessed 20 Mar 2020
go back to reference Ernst-Stecken A, Ganslandt O, Lambrecht U, Sauer R, Grabenbauer G (2007) Survival and quality of life after hypofractionated stereotactic radiotherapy for recurrent malignant glioma. J Neurooncol 81(3):287–294CrossRef Ernst-Stecken A, Ganslandt O, Lambrecht U, Sauer R, Grabenbauer G (2007) Survival and quality of life after hypofractionated stereotactic radiotherapy for recurrent malignant glioma. J Neurooncol 81(3):287–294CrossRef
go back to reference Fayers PM, Aaronson NK, Bjordal K et al (2001) European Organization for Research and Treatment of Cancer QLQ-C30 scoring manual, 3rd edn. EORTC, Brussels Fayers PM, Aaronson NK, Bjordal K et al (2001) European Organization for Research and Treatment of Cancer QLQ-C30 scoring manual, 3rd edn. EORTC, Brussels
go back to reference Galle J, McDonald M, Simoneaux V, Buchsbaum J (2015) Reirradiation with proton therapy for recurrent gliomas. Int J Part Ther 2(1):11–18CrossRef Galle J, McDonald M, Simoneaux V, Buchsbaum J (2015) Reirradiation with proton therapy for recurrent gliomas. Int J Part Ther 2(1):11–18CrossRef
go back to reference Hahn CA, Dunn RH, Logue PE, King JH, Edwards CL, Halperin EC (2003) Prospective study of neuropsychologic testing and quality-of life assessment of adults with primary malignant brain tumors. IJROBP 55(4):992–999 Hahn CA, Dunn RH, Logue PE, King JH, Edwards CL, Halperin EC (2003) Prospective study of neuropsychologic testing and quality-of life assessment of adults with primary malignant brain tumors. IJROBP 55(4):992–999
go back to reference Kazmi F, Soon YY, Leong YH, Koh WY, Vellayappan B (2019) Re-irradiation for recurrent glioblastoma (GBM): a systematic review and meta-analysis. J Neurooncol 142(1):79–90CrossRef Kazmi F, Soon YY, Leong YH, Koh WY, Vellayappan B (2019) Re-irradiation for recurrent glioblastoma (GBM): a systematic review and meta-analysis. J Neurooncol 142(1):79–90CrossRef
go back to reference Koshy M, Villano JL, Dolecek TA et al (2012) Improved survival time trends for glioblastoma using the SEER 17 population-based registries. J Neurooncol 107:207–212CrossRef Koshy M, Villano JL, Dolecek TA et al (2012) Improved survival time trends for glioblastoma using the SEER 17 population-based registries. J Neurooncol 107:207–212CrossRef
go back to reference Litofsky NS, Farace E, Anderson F Jr, Meyers CA, Huang W, Laws ER Jr (2004) Glioma Outcomes Project Investigators. Depression in patients with highgrade glioma: results of the Glioma Outcomes Project. Neurosurgery 54(2):358–366CrossRef Litofsky NS, Farace E, Anderson F Jr, Meyers CA, Huang W, Laws ER Jr (2004) Glioma Outcomes Project Investigators. Depression in patients with highgrade glioma: results of the Glioma Outcomes Project. Neurosurgery 54(2):358–366CrossRef
go back to reference Lupien SJ, Gillin CJ, Hauger RL (1999) Working memory is more sensitive than declarative memory to the acute effects of corticosteroids: a dose-response study in humans. Behav Neurosci 113(3):420–430CrossRef Lupien SJ, Gillin CJ, Hauger RL (1999) Working memory is more sensitive than declarative memory to the acute effects of corticosteroids: a dose-response study in humans. Behav Neurosci 113(3):420–430CrossRef
go back to reference Mainio A, Tuunanen S, Hakko H, Niemela A, Koivukangas J, Rasanen P (2006) Decreased quality of life and depression as predictors for shorter survival among patients with low-grade gliomas: a follow-up from 1990 to 2003. Eur Arch Psychiatry Clin Neurosci 256(8):516–521CrossRef Mainio A, Tuunanen S, Hakko H, Niemela A, Koivukangas J, Rasanen P (2006) Decreased quality of life and depression as predictors for shorter survival among patients with low-grade gliomas: a follow-up from 1990 to 2003. Eur Arch Psychiatry Clin Neurosci 256(8):516–521CrossRef
go back to reference Minniti G, Amelio D, Amichetti M et al (2010) Patterns of failure and comparison of different target volume delineations in patients with glioblastoma treated with conformal radiotherapy plus concomitant and adjuvant temozolomide. Radiother Oncol 97:377–438CrossRef Minniti G, Amelio D, Amichetti M et al (2010) Patterns of failure and comparison of different target volume delineations in patients with glioblastoma treated with conformal radiotherapy plus concomitant and adjuvant temozolomide. Radiother Oncol 97:377–438CrossRef
go back to reference 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(2):285–291CrossRef 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(2):285–291CrossRef
go back to reference Mizumoto M, Okumura T, Ishikawa E et al (2013) Reirradiation for recurrent malignant brain tumor with radiotherapy or proton beam therapy. Technical considerations based on experience at a single institution. Strahlenther Onkol 189(8):656–663CrossRef Mizumoto M, Okumura T, Ishikawa E et al (2013) Reirradiation for recurrent malignant brain tumor with radiotherapy or proton beam therapy. Technical considerations based on experience at a single institution. Strahlenther Onkol 189(8):656–663CrossRef
go back to reference Navarria P, Minniti G, Clerici E et al (2019) Re-irradiation for recurrent glioma: outcome evaluation, toxicity and prognostic factors assessment. A multicenter study of the Radiation Oncology Italian Association (AIRO). J Neurooncol 142(1):59–67CrossRef Navarria P, Minniti G, Clerici E et al (2019) Re-irradiation for recurrent glioma: outcome evaluation, toxicity and prognostic factors assessment. A multicenter study of the Radiation Oncology Italian Association (AIRO). J Neurooncol 142(1):59–67CrossRef
go back to reference Neider C, Nestle U, Niewald M, Walter K, Schnabel K (1999) Hyperfractionated reirradiation for malignant glioma. Front Radiat Ther Oncol 33:150–157CrossRef Neider C, Nestle U, Niewald M, Walter K, Schnabel K (1999) Hyperfractionated reirradiation for malignant glioma. Front Radiat Ther Oncol 33:150–157CrossRef
go back to reference Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16(1):139–144CrossRef Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16(1):139–144CrossRef
go back to reference Ryu S, Buatti JM, Morris A, Kalkanis SN, Ryken TC, Olson JJ (2014) AANS/CNS Joint Guidelines Committee the role of radiotherapy in the management of progressive glioblastoma: systematic review and evidence-based clinical practice guideline. J Neurooncol 118(3):489–499CrossRef Ryu S, Buatti JM, Morris A, Kalkanis SN, Ryken TC, Olson JJ (2014) AANS/CNS Joint Guidelines Committee the role of radiotherapy in the management of progressive glioblastoma: systematic review and evidence-based clinical practice guideline. J Neurooncol 118(3):489–499CrossRef
go back to reference Scartoni D, Amelio D, Giacomelli I, Amichetti M (2018b) Health related quality of life in recurrent glioblastoma treated with re-irradiation with active scanning protontherapy. Neuro-Oncology 20(Suppl_3):iii250CrossRef Scartoni D, Amelio D, Giacomelli I, Amichetti M (2018b) Health related quality of life in recurrent glioblastoma treated with re-irradiation with active scanning protontherapy. Neuro-Oncology 20(Suppl_3):iii250CrossRef
go back to reference Scartoni D, Amelio D, Farace P, Widesott L, Fellin F, Giacomelli I, Schwarz M, Amichetti M (2018c) Health related quality of life in large recurrence glioblastoma treated with active beam protontherapy. Radiother Oncol 133:S690 (April 2019) CrossRef Scartoni D, Amelio D, Farace P, Widesott L, Fellin F, Giacomelli I, Schwarz M, Amichetti M (2018c) Health related quality of life in large recurrence glioblastoma treated with active beam protontherapy. Radiother Oncol 133:S690 (April 2019) CrossRef
go back to reference Scoccianti S, Francolini G, Carta GA et al (2018) Re-irradiation as salvage treatment in recurrent glioblastoma: a comprehensive literature review to provide practical answers to frequently asked questions. Crit Rev Oncol Hematol 126:80–91CrossRef Scoccianti S, Francolini G, Carta GA et al (2018) Re-irradiation as salvage treatment in recurrent glioblastoma: a comprehensive literature review to provide practical answers to frequently asked questions. Crit Rev Oncol Hematol 126:80–91CrossRef
go back to reference Taphoorn MJ, Stupp R, Coens C et al (2005) Health-related quality of life in patients with glioblastoma: a randomised controlled trial. Lancet Oncol 6(12):937–944CrossRef Taphoorn MJ, Stupp R, Coens C et al (2005) Health-related quality of life in patients with glioblastoma: a randomised controlled trial. Lancet Oncol 6(12):937–944CrossRef
go back to reference Taphoorn MJ, Claassens L, Aaronson NK et al (2010a) An international validation study of the EORTC brain cancer module (EORTC QLQ-BN20) for assessing health-related quality of life and symptoms in brain cancer patients. Eur J Cancer 46:1033–1040CrossRef Taphoorn MJ, Claassens L, Aaronson NK et al (2010a) An international validation study of the EORTC brain cancer module (EORTC QLQ-BN20) for assessing health-related quality of life and symptoms in brain cancer patients. Eur J Cancer 46:1033–1040CrossRef
go back to reference Taphoorn MJ, Sizoo EM, Bottomley A (2010b) Review on quality of life issues in patients with primary brain tumors. Oncologist 15:618–626CrossRef Taphoorn MJ, Sizoo EM, Bottomley A (2010b) Review on quality of life issues in patients with primary brain tumors. Oncologist 15:618–626CrossRef
go back to reference Walker M, Brown J, Brown K et al (2003) Practical problems with the collection and interpretation of serial quality of life assessments in patients with malignant glioma. J Neurooncol 63(2):179–186CrossRef Walker M, Brown J, Brown K et al (2003) Practical problems with the collection and interpretation of serial quality of life assessments in patients with malignant glioma. J Neurooncol 63(2):179–186CrossRef
go back to reference Wick W, Fricke H, Junge K et al (2014) A phase II, randomized, study of weekly APG101 + reirradiation versus reirradiation in progressive glioblastoma. Clin Cancer Res 20(24):6304–6313CrossRef Wick W, Fricke H, Junge K et al (2014) A phase II, randomized, study of weekly APG101 + reirradiation versus reirradiation in progressive glioblastoma. Clin Cancer Res 20(24):6304–6313CrossRef
go back to reference Young AH, Sahakian BJ, Robbins TW, Cowen PJ (1999) The effects of chronic administration of hydrocortisone on cognitive function in normal male volunteers. Psychopharmacology 145(3):260–266CrossRef Young AH, Sahakian BJ, Robbins TW, Cowen PJ (1999) The effects of chronic administration of hydrocortisone on cognitive function in normal male volunteers. Psychopharmacology 145(3):260–266CrossRef
Metadata
Title
Proton therapy re-irradiation preserves health-related quality of life in large recurrent glioblastoma
Authors
Daniele Scartoni
Dante Amelio
Pierpaolo Palumbo
Irene Giacomelli
Maurizio Amichetti
Publication date
01-06-2020
Publisher
Springer Berlin Heidelberg
Published in
Journal of Cancer Research and Clinical Oncology / Issue 6/2020
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI
https://doi.org/10.1007/s00432-020-03187-w

Other articles of this Issue 6/2020

Journal of Cancer Research and Clinical Oncology 6/2020 Go to the issue