Optimal timing of chemoradiotherapy after surgical resection of glioblastoma: Stratification by validated prognostic classification

Press, Robert H.; Shafer, Sarah L.; Jiang, Renjian; Buchwald, Zachary S.; Abugideiri, Mustafa; Tian, Sibo; Morgan, Tiffany; Behera, Madhusmita; Sengupta, Soma; Voloschin, Alfredo; Olson, Jeffrey J.; Hasan, Shaakir; Blumenthal, Deborah T.; Eaton, Bree R.; Shu, Hui‐Kuo G.; Zhong, Jim

doi:10.1002/cncr.32797

Cited by 21 publications

(16 citation statements)

References 34 publications

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“…First, rather than the percentage of extent of resection, clinicians might need to consider the absolute volume of remaining tumour tissue, including both enhancing and non-enhancing tumour tissue [45][46][47] . Second, early (<3 weeks) as opposed to later (3-5 weeks) initiation of postsurgical radiotherapy does not correlate with improved overall survival (OS) 48 . This finding is unexpected because one might predict that a longer time interval between surgery and start of radiotherapy would favour regrowth of the tumour and thus confer a survival disadvantage 47 .…”

Section: Recommendationsmentioning

confidence: 99%

“…The timing, dosing and scheduling of radiotherapy are determined by the disease subtype and prognostic factors, including age, KPS and residual tumour volume. Radiotherapy should start within 3-5 weeks after surgery 48 and is commonly administered at 50-60 Gy in 1.8-2 Gy daily fractions. No evidence suggests additional benefit from high-dose versus low-dose radiation in patients with WHO grade 2 gliomas 52 and, for those with higher WHO grade tumours, no data from randomized studies support the use of doses >60 Gy (ref.…”

Section: Radiotherapymentioning

confidence: 99%

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EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood

et al. 2020

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In response to major changes in diagnostic algorithms and the publication of mature results from various large clinical trials, the European Association of Neuro-Oncology (EANO) recognized the need to provide updated guidelines for the diagnosis and management of adult patients with diffuse gliomas. Through these evidence-based guidelines, a task force of EANO provides recommendations for the diagnosis, treatment and follow-up of adult patients with diffuse gliomas. The diagnostic component is based on the 2016 update of the WHO Classification of Tumors of the Central Nervous System and the subsequent recommendations of the Consortium to Inform Molecular and Practical Approaches to CNS Tumour Taxonomy — Not Officially WHO (cIMPACT-NOW). With regard to therapy, we formulated recommendations based on the results from the latest practice-changing clinical trials and also provide guidance for neuropathological and neuroradiological assessment. In these guidelines, we define the role of the major treatment modalities of surgery, radiotherapy and systemic pharmacotherapy, covering current advances and cognizant that unnecessary interventions and expenses should be avoided. This document is intended to be a source of reference for professionals involved in the management of adult patients with diffuse gliomas, for patients and caregivers, and for health-care providers.

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Section: Recommendationsmentioning

confidence: 99%

Section: Radiotherapymentioning

confidence: 99%

EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood

et al. 2020

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“…The impact of timing of subsequent therapy on OS is still unclear. Nevertheless different studies indicate that a delay of more than 42 days should be avoided [7][8][9][10][11][12]. We observed a signi cantly higher mean time to initiation of subsequent therapy and a corresponding higher rate of delay of more than 42 days for patients with an AE.…”

Section: Discussionmentioning

confidence: 55%

“…However, the association of treatment delay of therapy and OS remains controversial. Although the relevance of the exact timing of subsequent therapy remains uncertain, a systemic review [7] and different studies [8][9][10][11][12][13][14] seem to agree that a moderate delay of subsequent chemoradiotherapy does not have a detrimental effect on OS, but a delay of more than 42 days after surgery might be associated with worse OS.…”

Section: Introductionmentioning

confidence: 99%

Association of perioperative adverse events with subsequent therapy and overall survival in patients with WHO grade III and IV gliomas

Weber¹,

Müller²,

Velz³

et al. 2021

Preprint

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Purpose Maximum-safe-resection followed by chemoradiotherapy as current standard of care for WHO grade III and IV gliomas can be influenced by the occurrence of perioperative adverse events (AE). The aim of this study was to determine the association of AE with the timing and choice of subsequent treatments as well as with overall survival (OS). Methods Prospectively collected data of 283 adult patients undergoing surgery for WHO grade III or IV gliomas at the University Hospital Zurich were analysed. We assessed basic patient characteristics, Karnofsky performance score (KPS), extent of resection (EOR), WHO grade, and we classified AE as well as modality, timing of subsequent treatment (delay, interruption or non-initiation) and OS. Results In 117 patients (41%), an AE was documented between surgery and 3-months follow-up. There was a significant association of AE with an increased time to initiation of subsequent therapy (p = 0.005) and a higher rate of interruption (p < 0.001) or non-initiation (p < 0.001). AE grades correlated with time to initiation of subsequent therapy (p = 0.038). AE were associated with shorter OS in univariate analysis (p < 0.001). Conclusion AE are associated with delayed and/or altered subsequent therapy and worse OS in WHO grade III and IV glioma patients. These data emphasize and quanitfy the importance of safety within the maximum-safe-resection concept.

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“…This is a novel nding that to our knowledge has not been previously identi ed among pediatric HGG, though recent studies in adult glioblastoma using the NCDB found similar results [15]. This study is limited in its retrospective design and the nding could be attributed to selection bias with patients demonstrating more aggressive histologies, more concerning imaging ndings or more aggressive clinical course initiating RT earlier.…”

Section: Discussionmentioning

confidence: 58%

The Impact of Radiation Therapy Variables on Pediatric High-Grade Glioma Outcomes: A National Cancer Database Analysis

Williamson¹,

Williamson²,

Jiang³

et al. 2021

Preprint

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Purpose Pediatric high-grade glioma (HGG) is a devastating disease with a poor prognosis. The purpose of this analysis is to evaluate the impact of Radiation Therapy (RT) variables on outcomes of pediatric HGG patients in the National Cancer Database (NCDB). Methods The NCDB was used to select patients age < 22 with histologically proven WHO Grade III and IV gliomas treated with ≥ 50Gy and < 76Gy RT between 2004 and 2013. RT variables including RT dose, timing between diagnosis and RT initiation (< 4 weeks, 4–6 weeks, or > 6 weeks), and RT modality were analyzed along with baseline demographic, tumor and treatment variables to assess the impact on overall survival in univariate and multivariable analyses. Results 498 pediatric HGG patients were included. Histologies included glioblastoma (30%), astrocytoma (55%), oligogendroglioma (5%) and gliomas not otherwise specific (10%). The median RT dose was 59.4 Gy (SD 2.9 Gy) starting a median of 4.4 weeks from diagnosis (SD 2.5 weeks). Median follow-up was 19.6 months with 1- and 3-year OS of 78.4% and 40.4%, respectively. On Multivariable analysis, female gender, older age, and private insurance remained independently associated with lower rate of overall death. Radiation initiation ≤ 4 weeks from diagnosis, and glioblastoma histology were significantly associated with higher rate of overall death. There was no relationship between radiation dose or whether radiation was delivered with proton or photon therapy and overall survival. Conclusions Outcomes for pediatric HGG are poor. Early initiation of RT within 4 weeks from diagnosis was negative associated with overall survival and may be related to unknown prognostic factors.

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Optimal timing of chemoradiotherapy after surgical resection of glioblastoma: Stratification by validated prognostic classification

Cited by 21 publications

References 34 publications

EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood

EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood

Association of perioperative adverse events with subsequent therapy and overall survival in patients with WHO grade III and IV gliomas

The Impact of Radiation Therapy Variables on Pediatric High-Grade Glioma Outcomes: A National Cancer Database Analysis

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