The impact of the time to start radiation therapy on overall survival in newly diagnosed glioblastoma

Santos, Vilmara Almeida dos; Marta, Gustavo Nader; Mesquita, Marcella Coelho; López, Rossana Verónica Mendoza; Cavalcante, Edla Renata; Feher, Olavo

doi:10.1007/s11060-019-03137-8

Cited by 9 publications

(3 citation statements)

References 29 publications

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“…However, our ndings did not suggest that radiation therapy was unnecessary for the treatment of newly diagnosed GBM. As various previous studies have shown, [21][22][23] radiation therapy was undoubtedly bene cial for the OS of patients with GBM. In our study, almost all patients (nearly 90%) received radiation therapy.…”

Section: Discussionmentioning

confidence: 73%

A prognostic model of newly diagnosed glioblastoma based on clinical characteristics

Sun¹,

Fan²,

Wang³

et al. 2020

Preprint

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Background Using isocitrate dehydrogenase (IDH) mutations to classify survival outcomes of patients with glioblastoma multiforme was recommended based on novel histopathological classification of brain tumors. Considering this novel classification, it is unclear whether the extent of tumor resection (EOR) is still important. The aim of this study was to investigate prognostic value of clinical factors (age, sex, EOR, status of IDH mutations, and adjuvant therapy) in patients with newly diagnosed glioblastoma. Methods In total, 269 patients were retrospectively enrolled and randomly divided into training (n = 179) and validation (n = 90) cohorts. Clinical information and survival outcomes were acquired from inpatient records and follow-ups. After adjusting for risk coefficients, the independent prognostic factors were selected in a multivariable analysis to generate a model to evaluate survival outcomes. Additionally, a receiver operating characteristic curve was used to assess accuracy for predicting survival outcomes at 12, 15, 18, and 24 months. Results Total resection of the contrast-enhanced region, age ≤ 60 years, received chemotherapy, and IDH mutations were favorable independent factors for overall survival. Area under the curve (AUC) for prediction of survival in the training cohort was 0.815, 0.851, 0.849, and 0.836 at 12, 15, 18, and 24 months, respectively. In the validation cohort, the AUC for prediction of survival was 0.780, 0.807, 0.836, and 0.849 at 12, 15, 18, and 24 months, respectively. Conclusion Total resection of the contrast-enhanced region is still crucial and recommended for patients with glioblastoma. Our prognostic model was able to predict survival outcomes, especially for long-term survival prediction.

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Section: Discussionmentioning

confidence: 73%

A prognostic model of newly diagnosed glioblastoma based on clinical characteristics

Sun¹,

Fan²,

Wang³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Moreover, a second study by Blumenthal et al 4 evaluated the results from their first work mentioned earlier within the era of TMZ and found no statistically significant impact of time to irradiation in patients treated according to the Stupp regimen. Recent results from study cohorts treated to current glioma guidelines 5,6 confirmed that the beginning of radiotherapy within the first 6 weeks after GBM diagnosis seems to be safe, independently from earlier or later initiation. Finally, the so far largest post hoc analysis utilizing records from more than 15,000 patients of the NCDB estimated day 61 as threshold for beneficial effects of TRT on GBM patient survival.…”

Section: Discussionmentioning

confidence: 94%

“…This vague recommendation is based on preventing patients from harm by starting radiotherapy too early while not delaying important therapy, paying attention to the fast-growing nature of GBM. Several works addressed this issue, especially during the past few years, 4 5 6 and evidence is rising that it is safe for GBM patients to postpone adjuvant therapy past 4 weeks after resection. Moreover, technical advances, such as brain mapping, 7 8 intraoperative magnetic resonance imaging (MRI), 9 awake craniotomy, 10 or fluorescence-based resection after application of 5-aminolevulinic acid, 11 helped in improving the extent of resection (EOR), but it is not always reasonable to remove all of the macroscopically visible tumor to preserve neurologic function.…”

Section: Introductionmentioning

confidence: 99%

The Role of Delayed Radiotherapy Initiation in Patients with Newly Diagnosed Glioblastoma with Residual Tumor Mass

Kasper

Frydrychowicz

Jähne

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Objective Treatment for newly diagnosed isocitrate dehydrogenase (IDH) wild-type glioblastoma (GBM) includes maximum safe resection, followed by adjuvant radio(chemo)therapy (RCx) with temozolomide. There is evidence that it is safe for GBM patients to prolong time to irradiation over 4 weeks after surgery. This study aimed at evaluating whether this applies to GBM patients with different levels of residual tumor volume (RV). Methods Medical records of all patients with newly diagnosed GBM at our department between 2014 and 2018 were reviewed. Patients who received adjuvant radio (chemo) therapy, aged older than 18 years, and with adequate perioperative imaging were included. Initial and residual tumor volumes were determined. Time to irradiation was dichotomized into two groups (≤28 and >28 days). Univariate analysis with Kaplan–Meier estimate and log-rank test was performed. Survival prediction and multivariate analysis were performed employing Cox proportional hazard regression. Results One hundred and twelve patients were included. Adjuvant treatment regimen, extent of resection, residual tumor volume, and O6-methylguanine DNA methyltransferase (MGMT) promoter methylation were statistically significant factors for overall survival (OS). Time to irradiation had no impact on progression-free survival (p = 0.946) or OS (p = 0.757). When stratified for different thresholds of residual tumor volume, survival predication via Cox regression favored time to irradiation below 28 days for patients with residual tumor volume above 2 mL, but statistical significance was not reached. Conclusion Time to irradiation had no significant influence on OS of the entire cohort. Nevertheless, a statistically nonsignificant survival prolongation could be observed in patients with residual tumor volume > 2 mL when admitted to radiotherapy within 28 days after surgery.

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Mini-craniotomy for intra-axial brain tumors: a comparison with conventional craniotomy in 306 patients harboring non-dural based lesions

et al. 2022

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The impact of the time to start radiation therapy on overall survival in newly diagnosed glioblastoma

Cited by 9 publications

References 29 publications

A prognostic model of newly diagnosed glioblastoma based on clinical characteristics

A prognostic model of newly diagnosed glioblastoma based on clinical characteristics

The Role of Delayed Radiotherapy Initiation in Patients with Newly Diagnosed Glioblastoma with Residual Tumor Mass

Mini-craniotomy for intra-axial brain tumors: a comparison with conventional craniotomy in 306 patients harboring non-dural based lesions

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