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

Abstract 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-[ 18 F]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.