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Brain lesions associated with communication-related quality of life following surgical removal of primary left-hemisphere tumours

Poster C75 in Poster Session C, Friday, October 7, 10:15 am - 12:00 pm EDT, Millennium Hall

Elaine Kearney¹, Sonia Brownsett^2,3, David Copland^2,3, Katharine Drummond^4,5, Rosalind Jeffree⁶, Sarah Olson⁷, Emma Murton⁴, Benjamin Ong⁷, Gail Robinson², Valeriya Tolkacheva¹, Katie McMahon^1,6, Greig de Zubicaray¹; ¹Queensland University of Technology, Brisbane, Australia, ²University of Queensland, Brisbane, Australia, ³Centre of Research Excellence in Aphasia Recovery and Rehabilitation, ⁴Royal Melbourne Hospital, Parkville, Australia, ⁵University of Melbourne, Melbourne, Australia, ⁶Royal Brisbane & Women’s Hospital, Brisbane, Australia, ⁷Princess Alexandra Hospital, Brisbane, Australia

Introduction. Long-term quality of life (QOL) is an important consideration in the planning of treatment for individuals undergoing brain tumour surgery, especially given that this population are at increased risk of aphasia. The current study examined relationships between QOL and anatomical characteristics of the lesion in patients 6-24 months post-surgery. Methods. Thirty-seven individuals (17 female; mean age: 47.24) underwent behavioural testing and MRI following left-hemisphere resective surgery. The majority of participants met the criteria for aphasia on at least one subtest of the Comprehensive Aphasia Test (CAT). QOL was assessed using the CAT Disability Questionnaire, the Depression, Anxiety, and Stress Scale (DASS), and the Functional Assessment of Cancer Therapy-Brain (FACT-Br), resulting in 10 QOL measures. A principal component analysis of these measures identified two components explaining ~62% of the variance: a communication-related component and a mood-related component. Three lesion maps were generated per participant capturing (1) the primary resection, (2) the resection plus residual tumour/oedema (resection+), and (3) the residual tumour/oedema alone. The relationship between QOL components and lesion location were examined using voxel-wise lesion symptom-mapping (VLSM) as well as general linear models predicting severity of tract- and voxel-wise disconnection. The tract-wise analysis focused on the five major dorsal and ventral language tracts from the Human Connectome Project (HCP-842), while the voxel-wise analysis covered the whole brain. Results. On average, QOL scores were within normal limits for all measures except for anxiety, which was rated as mild. A wide range of QOL scores was, however, observed. Maximum overlap of the primary resection lesions occurred in the left superior medial frontal region, while maximum overlap of both the resection+ and residual lesions occurred in the left posterior temporoparietal region. The VLSM analyses showed that communication-related QOL, but not mood-related QOL, was significantly associated with lesions comprising both the resection+ and residual tumour in the left medial inferior parietal lobe. The tract-wise analyses of white matter disconnection severities failed to reach statistical significance. The voxel-wise analyses of white matter disconnection severities revealed significant associations between communication-related QOL and thalamostriatal fibres for the residual tumour lesions. Paradoxically, higher communication-related QOL was related to more severe disconnection. None of the analyses involving mood-related QOL or the primary resection lesion maps were significant. Summary. Despite evidence of chronic language impairment for the majority of participants, self-rated QOL was largely within normal limits. This may suggest either minimal impact of language impairment on QOL (e.g., due to more subtle deficits) or limited patient insight into their communicative ability due to parietal lobe damage. Communication-related QOL was associated with the resection+ and residual tumour lesion maps, highlighting the importance of progressive tumour infiltration in this population. Finally, higher communication-related QOL was associated with more severe thalamostriatal disconnection, which may also implicate a mechanism for lack of awareness of deficits. Future studies may benefit from obtaining measures of awareness of impairment and corroborating evidence of QOL from family members.

Topic Areas: Disorders: Acquired, Language Production