BACKGROUND:High-grade glioma (HGG) patients experience enormous disease burden both from tumor- and treatment-related symptoms. Exercise can improve physical fitness and quality of life (QoL); yet experience in neuro-oncology, especially with high-intensity exercise, remains limited. This study evaluated feasibility, safety, and efficacy of the intensive, structured 16-week strength and endurance program, "Active in Neuro-Oncology" (ActiNO) for HGG patients undergoing chemotherapy. METHODS:In this prospective, oligocentric, single-arm proof-of-concept trial, 54 HGG patients participated in ActiNO, with twice-weekly supervised exercise sessions. The primary endpoint was cardiorespiratory fitness, assessed via physical working capacity (PWC75%)-the workload (W/kg body weight) achieved at 75% of age-adjusted maximum heart rate during a maximal cardiopulmonary exercise test. Secondary endpoints included peak oxygen uptake (VO2peak), peak power output (Ppeak), and QoL (EORTC QLQ-C30). Analyses focused on within-subject changes from pre- to post-intervention. Additionally, comparisons to normative data were performed. Feasibility was assessed via accrual, adherence, and attrition; safety via adverse event monitoring (CTCAE). RESULTS:Program tolerance was high, with few exercise-related adverse events (all CTCAE grade 1-2). Over 16 weeks, significant improvements were observed in PWC75% (1.023-1.256 W/kg BW, +23%), VO2peak (23.04-26.09 ml/min/kg BW, +13%), and Ppeak (1.771-2.104 W/kg BW, +19%). QoL, including global health and physical functioning, improved, reaching normative values. Adherence was high (85%), though attrition was 48%, mainly due to disease progression or physical constraints. CONCLUSIONS:High-intensity exercise is feasible and safe in HGG patients undergoing chemotherapy. The observed improvements in physical fitness and QoL support incorporating structured exercise into neuro-oncology care.

While glioblastoma is the most common malignant brain tumor in adults, extracerebral manifestations are very rare in this highly aggressive disease with poor prognosis. We conducted a systematic literature review in the PubMed database and complemented the data by inclusion of a case treated in our clinic. In this context, we report on a 60-year-old woman with a right frontal glioblastoma, IDH wildtype, MGMT methylated. Six months after initial diagnosis and primary treatment, there was extensive local intracranial progression with additional extension into the subcutaneous and frontotemporal cranial bones. Despite continuation of multimodal treatment, further extracerebral manifestations occurred 11 months after the initial diagnosis, both in the cranial bone as well as metastases in the right parotid gland, cervical lymph nodes, and lungs. While local radiotherapy enabled the cerebral lesions to be controlled, the patient’s clinical condition deteriorated rapidly despite simultaneous systemic therapy. The treatment had to be discontinued, and the patient died 5 weeks after confirmation of the multilocal extracerebral manifestations and a total of 12 months after initial diagnosis. Extracerebral manifestations of glioblastoma require close collaboration and joint decision-making with the patient, with an emphasis on palliative strategies.

Background Glioblastoma (GBM) remains incurable despite multimodal therapeutic approaches. Here, we assessed the relevance of ABO blood groups for progression-free survival (PFS), overall survival (OS), and long-term survival in a large cohort of isocitrate dehydrogenase (IDH)-wildtype (wt) GBM patients.Methods Consecutive GBM patients (2009-2020) at a large tertiary brain tumor center were included, and clinical data were retrospectively abstracted. We dichotomized patients into those with blood group O and those with a Non-O blood group. Patient, tumor, and treatment characteristics were compared between these groups. Association with outcomes was assessed in univariable and multivariable settings via log-rank tests and Cox proportional hazards regressions, respectively.Results Five hundred fifty-four GBM IDH-wt had available ABO information. There were no substantial differences in patient, tumor, or treatment characteristics between group O and group Non-O. In contrast, blood group O patients showed increased PFS, OS, and 5-year survivals in both univariable and multivariable analyses. Differences were strongly pronounced in patients with MGMT promoter methylated tumors receiving standardized radiochemotherapy (OS blood group O 24.6 months [95%CI 17.8-31.4] vs Non-O 17.7 months [14.1-21.3], P = .015 log-rank analysis, hazard ratio 0.70 [95%CI 0.53-0.94]), but not apparent in MGMT promoter unmethylated tumors and in patients without (standardized) adjuvant therapy.Conclusion Blood group O status in conjunction with MGMT promoter methylation (including weak methylation) is an independent favorable prognostic marker in GBM IDH-wt patients receiving standardized radiochemotherapy. This finding is unprecedented, suggesting a linkage between the downregulation of a DNA repair protein and the absence of a functional blood cell surface glycosyltransferase.

Abstract Background Glioblastoma (GBM) remains incurable despite multimodal therapeutic approaches. Here, we assessed the relevance of ABO blood groups for progression-free (PFS), overall survival (OS), and long-term survival in a large cohort of IDH-wildtype (wt) GBM patients. Methods Consecutive GBM patients (2009-2020) at a large tertiary brain tumour centre were included, and clinical data were retrospectively abstracted. We dichotomised patients into those with blood group O and those with a Non-O blood group. Patient, tumour, and treatment characteristics were compared between these groups. Association with outcomes was assessed in univariable and multivariable settings via log-rank tests and Cox proportional hazards regressions, respectively. Results 554 GBM IDH-wt had available ABO information. There were no substantial differences in patient, tumour, or treatment characteristics between group O and group Non-O. In contrast, blood group O patients showed increased PFS, OS, and five-year survivals in both univariable and multivariable analyses. Differences were strongly pronounced in patients with MGMT promoter methylated tumours receiving standardised radiochemotherapy (OS blood group O 24.6 months (95%CI 17.8–31.4) versus Non-O 17.7 months (14.1–21.3), p=0.015 log-rank analysis, hazard ratio 0.70 (95%CI 0.53-0.94)), but not apparent in MGMT promoter unmethylated tumours and in patients without (standardised) adjuvant therapy. Conclusion Blood group O status in conjunction with MGMT promoter methylation (including weak methylation) is an independent favourable prognostic marker in GBM IDH-wt patients receiving standardised radiochemotherapy. This finding is unprecedented, suggesting a linkage between the downregulation of a DNA repair protein and the absence of a functional blood cell surface glycosyltransferase.

Sarcopenia may complicate treatment in cancer patients. Herein, we assessed whether sarcopenia measurements derived from radiation planning computed tomography (CT) were associated with complications and tumor progression during radiochemotherapy for glioblastoma. Consecutive patients undergoing radiotherapy planning for glioblastoma between 2010 and 2021 were analyzed. Retrocervical muscle cross-sectional area (CSA) was measured via threshold-based semi-automated radiation planning CT analysis. Patients in the lowest sex-specific quartile of muscle measurements were defined as sarcopenic. We abstracted treatment characteristics and tumor progression from the medical records and performed uni- and multivariable time-to-event analyses. We included 363 patients in our cohort (41.6

IntroductionCommunication deficits have a severe impact on our social interactions and health-related quality of life. Subtle communication deficits are frequently overlooked or neglected in brain tumour patients, due to insufficient diagnostics. Digital tools may represent a valuable adjunct to the conventional assessment or therapy setting but might not be readily suitable for every patient.MethodsThis article summarises results of three surveys on the readiness for telemedicine among (a) patients diagnosed with high-grade glioma, (b) matched controls, and (c) speech and language therapists. The respective surveys assessed the motivation for participation in telemedical assessments and supposed influencing factors, and the use potential of digital assessment and therapy technologies in daily routine, with a spotlight on brain tumour patients and the future prospects of respective telemedical interventions. Respondents included 56 high-grade glioma patients (age median: 59 years; 48% males), 73 propensity-score matched neurologically healthy controls who were instructed to imagine themselves with a severe disease, and 23 speech and language therapists (61% <35 years; all females).Results and discussionThe vast majority of the interviewed high-grade glioma (HGG) patients was open to digitisation, felt well-equipped and sufficiently skilled. The factorial analysis showed that digital offers would be of particular interest for patients in reduced general health condition (p = 0.03) and those who live far from specialised treatment services (p = 0.03). The particular motivation of these subgroups seemed to outweigh the effects of age, equipment and internet skills, which were only significant in the control cohort. The therapists' survey demonstrated a broad consensus on the need for improving the therapy access of brain tumour patients (64%) and strengthening their respective digital participation (78%), although digitisation seems to have yet hardly entered the therapists' daily practise. In summary, the combined results of the surveys call for a joint effort to enhance the prerequisites for digital participation of patients with neurogenic communication disorders, particularly in the context of heavily burdened HGG patients with limited mobility.

Maximal cardiopulmonary exercise testing (max. CPET) provides the most accurate measurement of cardiorespiratory fitness. However, glioblastoma (GBM) patients often undergo less intensive tests, e.g., 6-min walk test or self-rating scales. This study aims to demonstrate feasibility and safety of max. CPET in GBM patients, concurrently evaluating their physical fitness status. Newly diagnosed GBM patients undergoing adjuvant chemotherapy were offered participation in an exercise program. At baseline, max. CPET assessed cardiorespiratory fitness including peak oxygen consumption (VO2peak), peak workload, and physical work capacity (PWC) at 75

Objective Treatment for malignant gliomas involves multiple disciplines, including neurosurgery, radiation therapy, medical and neuro-oncology, and palliative medicine, with function-preserving neurosurgical tumor removal being crucial. However, real-world data on hospital cases, treatment types, especially regarding surgical approaches, and the associated complication and mortality rates in Germany are lacking. Methods We analyzed data on hospital cases involving malignant gliomas (ICD-10-GM code C71) from the German 21 Hospital Remuneration Act, provided by the Institute for the Hospital Remuneration System (InEK GmbH), from 2019 to 2022. Our focus was on neuro-oncological operations defined by the German Cancer Society (DKG) and included specific operation and procedure (OPS) codes. Results From 2019 to 2022, there were 101,192 hospital cases involving malignant gliomas in Germany. Neurosurgical tumor removal was performed in 27,193 cases (26.9%). Microsurgical techniques were used in 95% of surgeries, intraoperative navigation systems in 84%, fluorescence-guided surgeries in 45.6%, and intraoperative neurophysiological monitoring (IONM) in 46.4%. Surgical or medical complications occurred in 2903 cases (10.7%). The hospital mortality rate was 2.7%. Mortality was significantly higher in patients aged 65 and older (Odds ratio 2.9, p < 0.0001), and lower in cases using fluorescence-guided procedures (Odds ratio 0.8, p = 0.015) and IONM (Odds ratio 0.5, p < 0.0001). Conclusions Over the course of 4 years, over 100,000 hospital cases involving adult patients diagnosed with malignant gliomas were treated in Germany, with 27,193 cases undergoing tumor removal using various modern surgical techniques. The hospital mortality rate was 2.7%.

Exercise proved to reduce cancer-related symptoms and prolong survival in some cancer types. However, brain tumor patients are often advised against strenuous exercise. Here, we summarize our experience with a submaximal exercise program for glioma patients: ActiNO (Active in Neuro-Oncology). Glioma patients were invited to participate in the program. Since 2011, a sports scientist individualized two one-hour sessions per week adapted to the patients’ symptoms. One session consisted of bicycle ergometry (average workload: 75

Background and purposeGlioblastoma (GBM) patients face a strongly unfavorable prognosis despite multimodal therapy regimens. However, individualized mortality prediction remains imprecise. Harnessing routine radiation planning cranial computed tomography (CT) scans, we assessed cervical body composition measures as novel biomarkers for overall survival (OS) in GBM patients.Materials and methodsWe performed threshold-based semi-automated quantification of muscle and subcutaneous fat cross-sectional area (CSA) at the levels of the first and second cervical vertebral body. First, we tested this method’s validity by correlating cervical measures to established abdominal body composition in an open-source whole-body CT cohort. We then identified consecutive patients undergoing radiation planning for recent GBM diagnosis at our institution from 2010 to 2020 and quantified cervical body composition on radiation planning CT scans. Finally, we performed univariable and multivariable time-to-event analyses, adjusting for age, sex, body mass index, comorbidities, performance status, extent of surgical resection, extent of tumor at diagnosis, and MGMT methylation.ResultsCervical body composition measurements were well-correlated with established abdominal markers (Spearman’s rho greater than 0.68 in all cases). Subsequently, we included 324 GBM patients in our study cohort (median age 63 years, 60.8% male). 293 (90.4%) patients died during follow-up. Median survival time was 13 months. Patients with below-average muscle CSA or above-average fat CSA demonstrated shorter survival. In multivariable analyses, continuous cervical muscle measurements remained independently associated with OS.ConclusionThis exploratory study establishes novel cervical body composition measures routinely available on cranial radiation planning CT scans and confirms their association with OS in patients diagnosed with GBM.

Abstract BACKGROUND Cancer-related fatigue (CRF) is considered one of the most prevalent symptoms in brain tumor patients undergoing concurrent chemoradiation (approx. 80 % of those affected). Several studies have identified beneficial effects of physical activity on reducing CRF. However, few studies have examined the reduction of CRF by exercise in glioma patients. Here we present prospective data showing the effect of an intensive 16-week supervised exercise intervention on CRF in neuro-oncological patients. MATERIAL AND METHODS Between July 2020 and April 2023, patients with newly diagnosed glioblastoma and after surgery and concomitant radiochemotherapy have been recruited for this single-arm trial in progress. Participants have received a 16-week supervised training intervention on a 1:1-basis consisting of two intensive 50-minute sessions per week (bicycle ergometry at an average of 75 % of maximum heart rate and progressive whole-body resistance training). CRF has been assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C30). We calculated change scores (scores: 0-100; 100=max. fatigue) from baseline, after 8 weeks, and post-intervention (week 16). RESULTS So far, 26 glioblastoma patients (13 women) aged 35-84 years (mean 59 years) participated in the exercise intervention. All patients received adjuvant chemotherapy (50 % Stupp, 42 % CeTeG, 8 % other). Paired t-test indicated a statistically significant reduction in CRF from baseline to post-intervention (p=.030; 95 % CI: -0.5 - 24.2). Mean scores reduced from 40.4 to 36.2 (week 8) to 26.9 (week 16). However, the decrease between week 0 and week 8 was not yet significant (p=.281; 95 % CI: -7.6 - 13.6). CONCLUSION The present trial shows that a 16-week supervised exercise program can reduce CRF in glioblastoma patients despite adjuvant chemotherapy. Thus, and consistent with studies of exercise interventions in patients of other tumor types, glioblastoma patients have the opportunity to actively contribute to the reduction of tumor- and therapy-induced side effects through intensive physical training.