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DOI: http://dx.doi.org/10.20534/ESR-17-1.2-52-54
Ashrapov Jamshid Raufovich, Republican Scientific Center of Neurosurgery and Tashkent Medical Academy, Ministry of Public Health of the Republic of Uzbekistan E-mail: dr-jamshid@mail.ru
Quality of life before and after treatment for supratentorial brain tumors in children
Abstract: The analysis of data of 97 children with brain tumors of supratentorial localization was carried out. To estimate treatment efficacy was used a rating scale of quality of life. It was determined that the quality of life of patients with brain gliomas depends on localization of neoplastic process, histological properties of tumor, preoperative neurologic deficit and the patient's compensated condition.
Keywords: quality of life, brain glioma, central nervous system, pediatric age.
Introduction
Tumors of the central nervous system (CNS) occupy the second place in the structure of malignant neoplasms in children after leukemia. Hemispherical supratentorial tumors are represented mainly by astrocytic tumors [3; 6; 9].
Currently, the quality oflife is ofmuch attention when evaluating results and efficacy of treatment. In scientific medical literature, the concept of the quality oflife has been used since 1977. According to the reports of a conference of the American Society of Clinical Oncology, held in 1990, the quality of life is a main criterion for evaluating results and effectiveness of treatment of cancer patients [1; 2; 4; 5].
At the present, the most important task of neurosurgeons is not only tumor removal, but also improvement of the quality of life of patients by preserving the most important functional brain structures [6; 8; 10].
In domestic pediatrics, concept of the study of quality of life developed in the early XXI century. On the one hand, this concept allows returning to a fundamental principle of clinical practice "do not cure the disease, cure the patient", and, on the other hand, offers a well-developed methodology that allows to obtain reliable data of the quality of life of children both in clinical practice and in researches. Along with traditional clinical indicators, evaluation of the efficacy of the child's treatment should be based on the parameters of quality of life. The concept of "quality of life" in pediatrics includes the definition of "child's quality of life", main characteristics of the definition of "child's quality of life", the methodology of the study the quality of life and the main directions of studying the quality of life in pediatric patients [6; 7].
Hence, the quality of life of children with supratentorial brain gliomas is a main criterion for evaluating the patient's condition and treatment efficacy.
The purpose of study was to assess the efficacy of treatment of patients with supratentorial brain gliomas in the process of compre-
Materials and Methods
This study is based on the results of treatment of 97 children with supratentorial brain gliomas at the age from 10 months to 16 years, who were treated in pediatric neurosurgical department of RSCN. Clinical diagnosis and surgical approach were determined based on brain CT and MRI studies. Assessment of quality of life was conducted by a developed programme "scale for determining the quality of life of children with supratentorial tumors".
Comparative analysis of the quality of life was conducted prior to the operation and after surgery at the time of patient's discharge from hospital. In neurological status were observed movement disorders in 55 (56.7%) patients in the form ofparesis or plegia, different kind of speech disorders in 34 (35.0%) children, hypertensive symptoms in 91 (93.8%) sufferers, deterioration of psychic activity in 17 (17.5%) patients, and visual impairments in 11 (11.3%) patients, respectively. Epileptiform seizures were noted in 29 (29.9%) patients.
Results and Discussion
Postoperative rehabilitation is a component of comprehensive treatment for cerebral gliomas in children. All 97 patients received restorative treatment (RT) in the postoperative period, which included drug treatment, massage, and electrical stimulation. In the early postoperative period, all patients underwent drug therapy aimed to eliminate brain edema, microcirculatory and neurodynamical disorders. Drug treatment included preparations, improving synaptic transmission, vascular drugs, corticosteroids, and protease inhibitors. After drug therapy, patients had positive dynamics, manifested by increase in volume of motor function, restoration of speech, as well as regression of hypertensive symptoms.
Tumor localization also affected the results of treatment. Accordingly, at defeat of brain speech-motor areas, qualitative indicators were lower, indicating more significant neurological deficit and psychosocial disadaptation.
hensive treatment using a rating scale of quality of life.
Table 1. - Scale for determining the quality of life of children with supratentorial tumors
Clinical syndromes Qualitative characteristics Scores
1 2 3
I. Psycho-neurological status (80 points)
Norm 10
1. Level of consciousness Stun (response to verbal commands) 5
Stupor (response only to pain) or coma 0
Quality of life before and after treatment for supratentorial brain tumors in children
1 2 3
2. Headache, nausea, vomiting, dizziness (cerebral symptoms) None 10
Insignificant 5
Significant 0
3. Deterioration of psychic activity Absent 10
Loss of memory and remembering 5
Disintegration 0
Absent 10
4. Seizures Rare 5
Frequent 0
Absent 10
5. Motor and sensory disorders Hemiparesis and hemihypesthesia 5
Hemiplegia and hemianesthesia 0
Absent 10
6. Visual impairments Reduced vision 5
Blindness 0
Absent 10
7. Speech disorders Partial 5
Full 0
Absent 10
8. Extrapyramidal disorders Partial 5
Full 0
II. Social adaptation (20 points)
Family (home) and labor (social) adaptation Full employability and self-service (learning abilities and interests to playing activity). 20
Disability and self-service (learning abilities and interests to playing activity). 10
Incapacitated and not capable of learning and self-care (needs constant assistance). 0
Table 2 demonstrates that the quality of life is lower at local- tures. At localization of tumor in the occipital lobe, poor quality of
ization of tumor in fronto-parietal and fronto-temporal lobes that life was observed mainly in 1 (7.1%) patient, associated with visual
are responsible for motor and speech functions. The quality of life photopsia and quadrant hemianopsia. also depends on the prevalence of tumor in the brain medial struc-
Table 2. - Relationship between quality of life and tumor localization in the preoperative and postoperative periods
Quality of life in pre- and postoperative periods Localization of tumor Total
Frontoparietal Fronto-temporal Fronto-parie-to- temporal Temporo-parietal Occipital Medial structures
Abs % Abs % Abs % Abs % Abs % Abs % Abs %
Good Before surgery 2 11.1 3 17.6 2 11.7 3 23.0 6 42.8 3 16.6 19 19.5
After RT 8 44.4 9 52.9 7 41.1 6 46.1 11 78.5 8 44.4 49 50.5
Satisfactory Before surgery 5 27.7 4 23.5 6 35.3 4 30.7 7 50.0 5 27.7 31 31.9
After RT 6 33.3 5 29.4 7 41.1 6 46.1 3 21.4 7 38.8 34 35.0
Poor Before surgery 11 61.1 10 58.8 9 52.9 6 46.1 1 7.1 10 55.5 47 48.4
After RT 4 22.2 3 17.6 3 17.6 1 7.6 0 0 3 16.6 14 14.4
Table 3 shows that the efficacy of treatment also depended mors of III-IV grade (High grade) belonged to tumors of high-on malignancy grade of tumors. Tumors of I—II grade (Low malignancy grade. The higher malignancy grade, the lower the grade) belonged to tumors of low-grade malignancy, and tu- quality of life.
Table 3. - Dependence of the quality of life on anaplasia grade of tumor
Quality of life in pre- and postoperative periods Grade of malignancy Total
I grade of anaplasia II grade of anaplasia III grade of anaplasia IV grade of anaplasia
Abs % Abs % Abs % Abs % Abs %
Good Before surgery 7 7.2 6 6.1 4 4.1 2 2.06 19 19.5
After RT 18 18.5 11 11.3 11 11.3 9 9.2 49 50.5
Satisfactory Before surgery 10 10.3 8 8.2 7 7.2 6 6.1 31 31.9
After RT 5 5.1 9 9.2 9 9.2 11 11.3 34 35.0
Poor Before surgery 7 7.2 9 9.2 13 13.4 18 18.5 47 48.4
After RT 1 1.03 3 3.1 4 4.1 6 6.1 14 14.4
Conclusions
1. The efficacy of treatment of brain supratentorial gliomas depends on the severity of clinical manifestations of disease, localization of tumor, its size, malignancy grade, tumors prevalence in surrounding functionally important brain structures and volume ofremote tumors.
2. The total score of all indicators allows characterizing the quality oflife ofpatients at the time of examination. The increase in total score during patients follow-up indicates in a positive dynamics of the disease course or rehabilitation period, while its decrease indicates a negative trend.
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3. A scale developed by us for determining the quality of life of children with supratentorial tumors is adapted to patients with brain tumors and could be used for children with brain lesions of supratentorial localization of different origin (trauma, cancer, vascular diseases, etc.).
4. Comprehensive treatment, including surgical removal of tumor and the course of restorative treatment, helps improve the quality of life of patients in the postoperative period.
