The impact of brain lesions on health-related quality of life in patients with WHO CNS grade 3 or 4 glioma: a lesion-function and resting-state fMRI analysis

Alexander Heinzel; Felix M Mottaghy; Christian Filss; Gabriele Stoffels; Philipp Lohmann; Michel Friedrich; Nadim J Shah; Svenja Caspers; Carolin Weiss Lucas; Maximilian I Ruge; Norbert Galldiks; Gereon R Fink; Karl-Josef Langen; Martin Kocher

doi:10.1007/s11060-023-04254-1

The impact of brain lesions on health-related quality of life in patients with WHO CNS grade 3 or 4 glioma: a lesion-function and resting-state fMRI analysis

J Neurooncol. 2023 Feb;161(3):643-654. doi: 10.1007/s11060-023-04254-1. Epub 2023 Feb 7.

Authors

Alexander Heinzel^{1

2

3}, Felix M Mottaghy^{2

4

5}, Christian Filss^{1

2}, Gabriele Stoffels^{1

2}, Philipp Lohmann¹, Michel Friedrich¹, Nadim J Shah^{1

6

7}, Svenja Caspers^{1

8}, Carolin Weiss Lucas^{5

9}, Maximilian I Ruge^{5

10}, Norbert Galldiks^{1

5

11}, Gereon R Fink^{1

5

11}, Karl-Josef Langen^{1

2

5}, Martin Kocher^{12

13

14}

Affiliations

¹ Institute of Neuroscience and Medicine, Research Center Juelich, INM-1, -3, -4, -11, Juelich, Germany.
² Department of Nuclear Medicine, RWTH Aachen University Hospital, Aachen, Germany.
³ Department of Nuclear Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
⁴ Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands.
⁵ Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.
⁶ Juelich-Aachen Research Alliance (JARA), Section JARA-Brain, Juelich, Germany.
⁷ Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany.
⁸ Institute for Anatomy I, Medical Faculty and, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.
⁹ Department of General Neurosurgery, Faculty of Medicine and, University Hospital Cologne, University of Cologne, Cologne, Germany.
¹⁰ Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and, University Hospital Cologne, Cologne, Germany.
¹¹ Department of Neurology, Faculty of Medicine and, University Hospital Cologne, University of Cologne, Cologne, Germany.
¹² Institute of Neuroscience and Medicine, Research Center Juelich, INM-1, -3, -4, -11, Juelich, Germany. martin.kocher@uk-koeln.de.
¹³ Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany. martin.kocher@uk-koeln.de.
¹⁴ Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and, University Hospital Cologne, Cologne, Germany. martin.kocher@uk-koeln.de.

Abstract

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.

Keywords: Brain networks; Functional magnetic resonance tomography; Glioma; Positron emission tomography; Quality of life; Radiotherapy.

MeSH terms

Brain / pathology
Brain Neoplasms* / pathology
Glioma* / pathology
Humans
Magnetic Resonance Imaging
Positron-Emission Tomography
Quality of Life
World Health Organization