Short Delay in Initiation of Radiotherapy May Not Affect Outcome of Patients With Glioblastoma: A Secondary Analysis From the Radiation Therapy Oncology Group Database

Blumenthal, Deborah T.; Won, Minhee; Mehta, Minesh P.; Curran, Walter J.; Souhami, Luís; Michalski, Jeff M.; Rogers, C. Leland; Corn, Benjamin W.

doi:10.1200/jco.2008.18.9035

Cited by 102 publications

(112 citation statements)

References 40 publications

(16 reference statements)

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“…[3][4][5][6][7] As the extent of surgical resection is known to significantly impact patient prognosis [8][9][10] , whether "biopsy-only" GBM patients receive a significant survival benefit to CRT over radiotherapy (RT) alone is less clear.…”

Section: Introductionmentioning

confidence: 99%

Concurrent chemoradiotherapy versus radiotherapy alone for “biopsy‐only” glioblastoma multiforme

Kole

Park

Yeboa

et al. 2016

Cancer

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BACKGROUND Combined temozolomide and radiotherapy (RT) is the standard postoperative therapy for glioblastoma multiforme (GBM). However, the clearest benefit of concurrent chemoradiotherapy (CRT) observed in clinical trials has been among patients who undergo surgical resection. Whether the improved survival with CRT extends to patients who undergo “biopsy only” is less certain. The authors compared overall survival (OS) in a national cohort of patients with GBM who underwent biopsy and received either RT alone or CRT during the temozolomide era. METHODS The US National Cancer Data Base was used to identify patients with histologically confirmed, biopsy‐only GBM who received either RT alone or CRT from 2006 through 2011. Demographic and clinicopathologic predictors of treatment were analyzed using the chi‐square test, the t test, and multivariable logistic regression. OS was evaluated using the log‐rank test, multivariable Cox proportional hazard regression, and propensity score‐matched analysis. RESULTS In total, 1479 patients with biopsy‐only GBM were included, among whom 154 (10.4%) received RT alone and 1325 (89.6%) received CRT. The median age at diagnosis was 61 years. CRT was associated with a significant OS benefit compared with RT alone (median, 9.2 vs 5.6 months; hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.54‐0.76; P < .001). CRT was independently associated with improved OS compared with RT alone on multivariable analysis (HR, 0.71; 95% CI, 0.60‐0.85; P < .001). A significant OS benefit for CRT persisted in a propensity score‐matched analysis (HR, 0.72; 95% CI, 0.56‐0.93; P = .009). CONCLUSIONS The current data suggest that CRT significantly improves OS in patients with GBM who undergo biopsy only compared with RT alone and should remain the standard of care for patients who can tolerate therapy. Cancer 2016;122:2364–2370. © 2016 American Cancer Society.

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Section: Introductionmentioning

confidence: 99%

Concurrent chemoradiotherapy versus radiotherapy alone for “biopsy‐only” glioblastoma multiforme

Kole

Park

Yeboa

et al. 2016

Cancer

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“…An unanticipated yet significantly superior outcome was identified for patients for whom RT was delayed beyond 4 weeks from surgery [61].…”

Section: Timing Of Postsurgical Therapymentioning

confidence: 99%

Unmet needs in the treatment of glioblastoma

Mut

Schiff

2009

Expert Review of Anticancer Therapy

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“…These results were similar to those of burnet et al, who developed a mathematical model for analyzing the data of patients with glioblastoma and found that delayed RT led to a negative prognosis. 18 blumenthal et al retrospectively analyzed 2,855 patients from 1974 to 2003 9 and reported that the time from surgery to the start of RT should be a maximum of six weeks as per the Radiation Therapy Oncology Group protocol. In their analysis, the median survival time in a group with a delay of more than four weeks in the initiation of RT was 12.5 months compared with 9.2 months in a group with a delay of less than two weeks.…”

Section: Discussionmentioning

confidence: 99%

“…The addition of RT to treatment protocols in three randomized phase III trials demonstrated an approximate doubling of survival and has been the considered standard of care since the late 1970's. [6][7][8] The standard time for RT for most patients is between two and six weeks following surgery 6,[9][10][11][12] ; however, in certain resource-limited centers, it may be as long as…”

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confidence: 99%

The Potential Impact of Delayed Radiation Therapy on Patients with Glioblastoma

Alnaami

VanderPluym

Murtha

et al. 2013

Can. J. Neurol. Sci.

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790Glioblastoma is the most prevalent and aggressive primary malignant brain tumor in adults.1 Since the publication of Stupp et al., the standard of care for the treatment of glioblastoma includes maximal surgical resection followed by radiation therapy (RT) and concomitant and adjuvant temozolomide treatment. Despite the use of this state-of-the-art treatment regimen, the median survival time of patients with glioblastoma is only 14.6 months.1 Well-established favorable prognostic factors include the addition of RT and novel chemotherapeutic agents such as temozolomide, the maximal extent of surgical resection, younger age, and a higher Karnofsky Performance Score 2-5 . The addition of RT to treatment protocols in three randomized phase III trials demonstrated an approximate doubling of survival and has been the considered standard of care since the late 1970's. [6][7][8] The standard time for RT for most patients is between two and six weeks following surgery 6,9-12 ; however, in certain resource-limited centers, it may be as long as ABSTRACT: Background: Radiation therapy (RT) is the major component of glioblastoma treatment; however, the time to initiate RT after surgical intervention varies between institutions. Our study examined the time from diagnosis to the initiation of RT and its effects on overall patient survival. Methods: We retrospectively examined 267 patients with glioblastoma who received RT as part of their therapy in two Canadian tertiary care centers. The primary goal of the study is to assess if time to RT can predict/impact survival in glioblastoma patients. Results: The following variables were associated with an increased risk of death: hazard ratio (HR) of time to RT was 0.95 [95% confidence interval (CI), 0.91-0.99] for every extra week. HRs for the type of surgery (resection or biopsy) and type of management received (standard of care in comparison with RT regardless of chemotherapeutic agents other than concomitant and adjuvant temozolomide) were 0.50 (95% CI, 0.37-0.66) and 0.53 (95% CI, 0.38-0.75), respectively. HR for age was 1.02 (95% CI, 1.01-1.03) for every extra year. Standard 60 Gy RT HR was 0.70 [95% confidence interval (CI), 0.51-0.97] in younger patients. Conclusions:The time from diagnosis to the initiation of RT was found to be a significant prognostic factor for overall patient survival. The addition of temozolomide to the treatment protocol, age, standard RT dose in younger patients and extent of surgery are others factors associated with longer survival periods.RÉSUMÉ: Impact potentiel de la radiothérapie différée chez les patients atteints d'un glioblastome. Contexte : la radiothérapie (RT) est l'élément le plus important du traitement du glioblastome. Cependant, le moment du début de la RT après la chirurgie varie selon les institutions. le but de l'étude était d'examiner le temps écoulé à partir du moment où le diagnostic a été posé jusqu'au moment où la RT a été commencée et ses effets sur la survie globale des patients. Méthode : Nous avons examiné rétrospective...

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Short Delay in Initiation of Radiotherapy May Not Affect Outcome of Patients With Glioblastoma: A Secondary Analysis From the Radiation Therapy Oncology Group Database

Abstract: There is no evident reduction in survival by delaying initiation of RT within the relatively narrow constraint of 6 weeks. An unanticipated yet significantly superior outcome was identified for patients for whom RT was delayed beyond 4 weeks from surgery.

Cited by 102 publications

References 40 publications

Concurrent chemoradiotherapy versus radiotherapy alone for “biopsy‐only” glioblastoma multiforme

Concurrent chemoradiotherapy versus radiotherapy alone for “biopsy‐only” glioblastoma multiforme

Unmet needs in the treatment of glioblastoma

The Potential Impact of Delayed Radiation Therapy on Patients with Glioblastoma

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