Impact of time to initiation of radiotherapy on survival after resection of newly diagnosed glioblastoma

Abstract

Background and purpose To evaluate the effect of timing of radiotherapy (RT) on survival in patients with newly diagnosed primary glioblastoma (GBM) treated with the same therapeutical protocol. Materials and methods Patients with newly diagnosed primary GBM treated with the same therapeutical scheme between 2010 and 2015 in our institution were retrospectively reviewed. The population was trichotomized based on the time interval from surgery till initiation of RT (< 28 days, 28–33 days, > 33 days). Kaplan-Meier and Cox regression analyses were used to compare progression free survival (PFS) and overall survival (OS) between the groups. The influence of various extensively studied prognostic factors on survival was assessed by multivariate analysis. Results One-hundred-fifty-one patients met the inclusion criteria. Between the three groups no significant difference in PFS ( p = 0.516) or OS ( p = 0.902) could be demonstrated. Residual tumor volume (RTV) and midline structures involvement were identified as independent prognostic factors of PFS while age, O-6-Methylguanine Methyltransferase (MGMT) status, Ki67 index, RTV and midline structures involvement represented independent predictors of OS. Patients starting RT after a prolonged delay (> 48 days) exhibited a significantly shorter OS ( p = 0.034). Conclusion Initiation of RT within a timeframe of 48 days is not associated with worsened survival. A prolonged delay (> 48 days) may be associated with worse OS. RT should neither be delayed, nor forced, but should rather start timely, as soon as the patient has recovered from surgery.

Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in glioblastoma surgery

“…This study also found that a higher CCI score, a higher grade of surgical complications, and no postoperative radiotherapy were associated with poor survival after GBM surgery, as has been observed previously [ 47 – 49 ]. Further investigation is still necessary.…”

Cancer and COVID-19 — potentially deleterious effects of delaying radiotherapy

“…Postoperative radiotherapy cannot be deferred without affecting the survival outcomes of patients with high-grade gliomas: every week of radiotherapy delay beyond 2 weeks after surgery increases the risk of death by 8.9% 6 . Similarly, delaying the initiation of radiotherapy >48 days after surgery worsens the survival of patients with newly diagnosed glioblastoma by around 7 months (P = 0.003) 7 .…”

Mesenchymal Transformation: The Rosetta Stone of Glioblastoma Pathogenesis and Therapy Resistance

“…[ 3 ] Based on histological properties, gliomas are classified into four classes (grades I–IV), in which grade IV, commonly referred to as glioblastoma (GBM), is the most malignant form with an overall mean survival rate of 12–17 months from diagnosis. [ 4‐9 ] GBMs are highly heterogeneous in nature and tend to infiltrate surrounding areas making complete surgical resection (first line therapy) practically impossible. [ 10 ] The second line treatment for GBM, consisting of radiotherapy with concomitant temozolomide (TMZ) chemotherapy, also fails partly due to intrinsic and/or acquired radio and chemoresistance.…”