Search

Purpose In glioma patients, tumor development and multimodality therapy are associated with changes in health-related quality of life (HRQoL). It is largely unknown how different types and locations of tumor- and treatment-related brain lesions, as well as their relationship to white matter tracts and functional brain networks, affect HRQoL. Methods In 121 patients with pretreated gliomas of WHO CNS grades 3 or 4, structural MRI, O-(2-[18F]fluoroethyl)-L-tyrosine (FET) PET, resting-state functional MRI (rs-fMRI) and self-reported HRQoL questionnaires (EORTC QLQ-C30/BN20) were obtained. Resection cavities, T1-enhancing lesions, T2/FLAIR hyperintensities, and lesions with pathologically increased FET uptake were delineated. Effects of tumor lateralization, involvement of white matter tracts or resting-state network nodes by different types of lesions and within-network rs-fMRI connectivity were analyzed in terms of their interaction with HRQoL scores. Results Right hemisphere gliomas were associated with significantly less favorable outcomes in physical, role, emotional and social functioning, compared with left-sided tumors. Most functional HRQoL scores correlated significantly with right-sided white-matter tracts involvement by T2/FLAIR hyperintensities and with loss of within-network functional connectivity of right-sided nodes. Tumors of the left hemisphere caused significantly more communication deficits. Conclusion In pretreated high-grade gliomas, right hemisphere lesions are associated with reduced HRQoL scores in most functional domains except communication ability, compared to tumors of the left hemisphere. These relationships are mainly observed for T2/FLAIR lesions involving structural and functional networks in the right hemisphere. The data suggest that sparing the right hemisphere from treatment-related tissue damage may improve HRQoL in glioma patients.

Purpose Following multimodality therapy, glioma patients may suffer from reduced health-related quality of life (QoL). It is largely unknown how different types and locations of tumor- and treatment-related brain lesions, as well as their relationship to white matter tracts and functional brain networks, affect QoL. Methods In 121 patients with pretreated gliomas of WHO CNS grades 3 or 4, structural MRI, O-(2-[18F]fluoroethyl)-L-tyrosine (FET) PET, resting-state functional MRI (rs-fMRI) and self-reported QoL questionnaires (EORTC QLQ-C30/BN20) were obtained. Resection cavities, T1-enhancing lesions, T2/FLAIR hyperintensities, and lesions with pathologically increased FET uptake were delineated. Effects of tumor lateralization, affection of white matter tracts and rs-fMRI network nodes by different types of lesions, and within rs-fMRI functional connectivity on QoL were analyzed. Results Gliomas of the right hemisphere were associated with significantly less favorable outcomes in physical, role, emotional and social functioning, compared to left-sided tumors. Most QoL scores correlated significantly with the affection of right-sided white-matter tracts by T2/FLAIR hyperintensities and with the loss of within-network functional connectivity of right-sided functional nodes. Tumors of the left hemisphere caused significantly more communication deficits. Conclusion In pretreated high-grade gliomas, right hemisphere rather than left hemisphere lesions are associated with decreased quality of life in most domains, except communication ability. These impairments are associated mainly with T2/FLAIR lesions affecting white matter tracts and functional nodal connectivity in the right hemisphere. The data suggest that sparing the right hemisphere from treatment-related tissue damage may improve quality of life in glioma patients.