Introduction: Glioblastoma is the most frequent primary brain tumor. Because it is currently incurable, the goal of therapy is the optimization of the patient’s quality of life (QOL). While maximal surgical resection has been shown to improve survival and QOL, not all tumors can be safely resected. Tumor location is critical in screening surgical candidates, yet the impact of tumor location on QOL has never been convincingly demonstrated, possibly due to the prohibitively high sample size that standard statistical analyses would require. By using a novel computer-driven algorithm, we set out to investigate the impact of tumor location on QOL.
Methods: The tumors of fourty consecutive glioblastoma patients were segmented and registered to a Talairach-space standard brain image. The Euclidian distance between 90 brain regions and each tumor’s margin was calculated and correlated to the patients’ self-reported QOL as measured by the SNAS questionnaire. Multiple linear regression analyses were performed between QOL, tumor location and clinical parameters.
Results: QOL was statistically associated with proximity to three areas: the right para-hypocampal gyrus, the right posterior cingulate cortex and the right postcentral gyrus. We postulate that the adverse relation between proximity to these areas and QOL results from disruption in large-scale networks involved in high-order functions such as visuospatial memory. While harder to detect with a bedside clinical examination, such deficits are likely more impactful on QOL than those related to the motor cortex or Broca’s area.
Conclusions: Tumor proximity to the right para-hypocampal gyrus, the right posterior cingulate cortex and the right postcentral gyrus are associated with decreased QOL, probably via an impact in visuospatial functionning. While traditionally considered non-eloquent, these affected areas have more impact on QOL than any other brain region and this should be considered in the management strategies of glioma patients if QOL maintenance is to be a goal of treatment.
Patient Care: Maintenance of Quality of Life is the goal of therapy for glioblastoma patients. By understanding the impact of tumor location on QOL, surgical decisions can be better informed and QOL evolution better predicted.
Learning Objectives: - Discuss Quality of Life as the goal of glioblastoma treatment
- Review the clinical predictors of Quality of Life
- Assess the impact of tumor location on Quality of Life