The analysis of quality of life of patients with glioblastoma after adjuvant radiation therapy

Abstract

Background. Optimizing approaches to the treatment of patients with glioblastoma (GB) is an urgent task partly owing to the wider implementation of hypofractionated radiation therapy (HRT) regimens. At the same time, increasing survival without maintaining the patient’s quality of life (QoL) cannot be considered successful treatment. Purpose – to analyze QoL of patients with GB after adjuvant radiation treatment in the groups of standard and hypofractionated radiation regimens. Materials and methods. 159 patients with verified GB, who had undergone surgery in State Institution «Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine» over the period from 2014 to 2020, were divided into two groups according to the regimen of RT: SRT group (n = 49) – standard regimen (total dose 60.0 Gy in 30 fractions over 6 weeks); HRT group (n = 110) – hypofractionated regimen (total dose 52.5 Gy in 15 fractions over 3 weeks). The patients were surveyed about QoL three times during their follow-up (3, 6 and 12 months after RT) according to the Global Health Status Scale (GHSS), domains of insomnia and fatigue of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core-30 (QLQ-C30 version 3.0). Statistical analysis was performed separately for each group (SRT and HRT; intragroup analysis), as well as between SRT and HRT groups as comparison of independent groups with a different number of follow-up examinations for each period of the follow-up (intergroup analysis). Results. The H0 hypothesis about the absence of statistically significant difference between the results of three subsequent surveys according to the GHSS, domains of insomnia and fatigue in both SRT (p = 0.00003; p = 0.00002; p = 0.00002, respectively) and HRT (p = 0.00000; p = 0.00001; p = 0.00001, respectively) groups in the intragroup analysis according to the Friedman test was rejected. The pairwise comparison of the results of the second and the first survey (6 vs. 3 months) according to the Wilcoxon test showed a statistically significant decrease in QoL in the domain of insomnia (р = 0.000733) in SRT group and in the domain of fatigue (р = 0.016813) in HRT group. When comparing the results of the third and the second survey (12 vs. 6 months), the H0 hypothesis for all the studied parameters of QoL (GHS, insomnia, and fatigue) was rejected in both SRT and HRT groups (p ≤ 0.017 with the Bonferroni correction). When comparing the results of the third and the first survey (12 vs. 3 months), a statistically significant decrease in QoL in all studied parameters of QoL was observed: GHSS (р = 0.000078); fatigue (р = 0.000294); insomnia (р = 0.000318). The comparison of the results of these surveys in SRT group showed a statistically significant decrease of QoL in GHSS (р = 0.004650) and fatigue (p = 0.017938), with the level of statistical significance getting closer to the set critical value considering the Bonferroni correction. The intergroup analysis according to the Mann-Whitney U test showed a statistically significant advantage of HRT over SRT in all studied parameters of QoL in three subsequent surveys (p < 0.05). The ρ-test confirmed these data: HRT group patients had better parameters of QoL than SRT group patients over the whole period of the follow-up. Conclusions. The analysis of QoL according to the results of three subsequent surveys 3, 6, and 12 months after RT according to the GHSS, domains of insomnia and fatigue of the EORTC QLQ-C30 demonstrated a decrease in QoL of patients in both SRT and HRT groups. At the same time, a statistically significant advantage of HRT group over SRT group in all studied parameters of SRT was observed when the results of three subsequent surveys were compared. The proposed regimen of HRT for patients with primarily diagnosed GB may be considered an acceptable alternative to SRT in view of impact on QoL.