Patients diagnosed with glioblastoma—one of the most aggressive forms of brain cancer—face substantial challenges. A new study has highlighted key factors influencing survival for those with Karnofsky Performance Status (KPS) of 50% or higher, emphasizing the importance of such scores to evaluate their quality of life.
The study, which examined 98 patients with glioblastoma IDH-wildtype treated with temozolomide (TMZ) and radiotherapy (RT), found the median survival time with KPS ≥ 50% to be 13.3 months. The research indicates maintaining KPS at this level is not only beneficial but also integral to improving the overall quality of life for glioblastoma patients.
KPS is used extensively in clinical settings as it reflects patient functionality and their ability to manage daily activities, with scores beneath 50% indicating the need for significant care. The findings are particularly alarming as they show over half of glioblastoma patients typically have less than two years of life expectancy. Identifying factors associated with the maintenance of KPS ≥ 50% could allow for enhanced therapeutic outcomes.
The retrospective study, approved by the Fujita Health University ethics review committee, included data from patients treated there from 2007 to 2021. Key factors associated with longer KPS maintenance included preoperative KPS scores of at least 80%, the size of the residual tumor being less than 2 cm³, and the presence of methylated MGMT promoter—a marker widely recognized for its positive response to TMZ treatment.
According to multivariate analysis, the KPS at the start of RT emerged as particularly significant, along with the aforementioned factors. Patients showing these characteristics enjoyed substantially longer periods with KPS ≥ 50%. For example, the median survival time with KPS maintained at this level was 28.57 months for patients who met all three favorable criteria.
Previous studies have shown the extent of tumor removal is closely tied to patient survival outcomes, and this study reinforces the idea. Researchers advocate for maximal safe resection of glioblastomas, especially considering the impact of residual tumor size on patient performance status. Those with smaller residual tumors tend to maintain KPS for longer periods.
This emphasizes the need for clear surgical guidelines and patient care plans focused on achieving maximum tumor reduction without sacrificing patient quality of life. Notably, the analysis conducted included the use of BCNU wafers, and treatments like bevacizumab; yet these factors did not demonstrate significant influence as was initially expected.
Data revealed the importance of early intervention as surgery timings did not impact outcomes significantly, indicating the potential for awake surgeries—as delayed surgeries, sometimes needed for preparation, were not detrimental based on recovery time of glioblastoma patients. Observations conclude it is desirable to balance aggressive tumor removal with maintaining KPS right from the beginning of therapy.
The study’s authors urge caution as they acknowledge limitations, including the relatively small sample size and exclusion criteria, which may restrict the broader application of these findings. Nonetheless, insights on maintaining KPS ≥ 50% are invaluable as the metrics contribute not only to survival but also to the quality of life for glioblastoma patients.
To sum up, the study concludes with strong recommendations: glioblastoma patients treated with RT and TMZ should aim for KPS ≥ 80% at the initiation of radiotherapy, strive for optimal tumor removal, and inquire about MGMT promoter status, which can augment treatment responses and overall survival. Future research with larger cohorts is necessary to affirm these findings and broaden the application of the results.