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Clinical Neurology and Neurosurgery 134 (2015) 55–59Contents lists available at ScienceDirectClinical Neurology and Neurosurgeryjo ur nal home p age: www.elsevier.com/locate/clineuroRisk factors for glioblastoma therapy associated complicationsGenevieve Ening a,b,∗ , Fransiska Osterheld b , David Capper c,d , Kirsten Schmieder a,b ,Christopher Brenke a,ba Department of Neurosurgery, Knappschafts-Krankenhaus Bochum-Langendreer, Ruhr-University of Bochum, In der Schornau 23–25, 44892 Bochum,Germanyb Department of Neurosurgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1, 68167 Mannheim, Germanyc Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germanyd Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 224, 69120 Heidelberg, Germanya r t i c l e i n f oArticle history:Received 24 November 2014Received in revised form24 December 2014Accepted 3 January 2015Available online 9 January 2015Keywords:GlioblastomaSurvivalNeurologicalMedicalSurgical complicationsa b s t r a c tObjective: Thromboembolic events, seizures, neurologic symptoms and adverse effects from corticoste-roids and chemotherapies are frequent clinical complications seen in Glioblastoma (GB) patients. Theexact impact these have on dismal patient outcome has not been fully elucidated. We aimed at assessingtreatment associated complications, evaluating the impact on survival and defining risk factors.Methods: Two hundred and thirty three consecutive adult patients operated on for newly diagnosed GBat a single tertiary institution over a 5-year-period (2006–2011) were assessed. Demographic param-eters (age, gender, comorbidity status quantified by the Charlson-comorbidity-index (CCI), functionalstatus computed by the Karnofsky Performance Scale (KPS), tumor characteristics (size, location, IDH-1mutation and MGMT-Promotor-methylation-status) and treatment parameters (volumetrically quanti-fied extent of resection and adjuvant therapy) were retrospectively reviewed. Complications assessedwere recorded as neurological (N), surgical (S) and medical (M). Independent risk factor analysis wasperformed by the univariate and multivariate logistic regression method. Survival analysis was plottedby the Kaplan–Meier-method, influence of complication occurrence was evaluated by the log-rank test.Results: One hundred and fifty nine (68.2%) patients had a total of 281 complications (90 N, 174 M and17 S). Univariate analysis identified age (P = 0.003), KPS < 70 (P = 0.002), CCI > 3 (P = 0.03), eloquent tumorlocation (P = 0.001) and therapy other than the standard radio-chemotherapy with temozolomide therapy(P = 0.034) as risk factors for complications. Multivariate analysis extracted the eloquent tumor location(P = 0.007, odds ratio 1.94) as a significant predictor for complications. Having a complication significantlydecreased patient survival (P = 0.015).Conclusions: Complications significantly decrease GB patient survival. Age, poor functional status, otherthan standard adjuvant therapy and eloquent tumor location proved as significant risk factors for encoun-tering a therapy associated complication. Not extensive surgery or tumor size but surgery at eloquentlocations impacts complication occurrence the strongest with a 2 fold increased complication occurrencerisk.© 2015 Published by Elsevier B.V.1. IntroductionGlioblastoma (GB) constitutes the most malignant subtype ofprimary brain tumors and has a dismal 5-year patient survivalrate of less than 5% (CBTRUS http://www.cbtrus.org). Despite the∗Corresponding author at: Department of Neurosurgery, Ruhr-UniversityBochum, In der Schornau 23–25, D-44892 Bochum, Germany.Tel.: +49 23429980255; fax: +49 2342993609.E-mail addresses: genevieve.ening@gmail.com, genevieve.ening@kk-bochum.de(G. Ening).advances in diagnostics and multimodal therapeutic approachesinstigated in the last decade, individual patient survival remainsheterogeneous [1]. Although age and KPS are well-defined out-come prognosticators, further parameters with significant impacton GB disease treatment still remain to be described [2]. Cur-rent standard treatment comprises a combination of surgery(resection or biopsy), radiation and chemotherapy [2]. Radiationand chemotherapy are therapeutic modalities with significantproof of influencing survival [3]. The exact impact of surgery onoutcome remains indistinct [4]. Current reviews state that patientswith perioperative complications and surgically acquired deficitswere less likely to receive adjuvant therapy, again emphasizinghttp://dx.doi.org/10.1016/j.clineuro.2015.01.0060303-8467/© 2015 Published by Elsevier B.V.