Delayed initiation of radiotherapy for glioblastoma: how important is it to push to the front (or the back) of the line?
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Glioblastoma is a malignant tumor characterized by a rapid proliferation rate. Contemporary multi-modality treatment consists of maximal surgical resection followed by radiation therapy (RT) combined with cytotoxic chemotherapy. The optimal timing of these different steps is not known. Four studies from the pre-temozolomide era, encompassing a total of 4,584 subjects, have examined the consequences of a delay between resection and starting RT. Whereas the two small single-institution studies found this delay to be detrimental, two large multi-institutional studies found delay to be either slightly beneficial or at least not harmful. Here, we critically compare the methodologies and results presented in these studies, and include a novel analysis of the combined datasets. We conclude that moderate wait periods (up to 4–6 weeks post-operatively) are safe and may be modestly beneficial. Conversely, there is no evidence to justify waiting longer than 6 weeks. Underlying radiobiological principles are discussed.
- Delayed initiation of radiotherapy for glioblastoma: how important is it to push to the front (or the back) of the line?
Journal of Neuro-Oncology
Volume 105, Issue 1 , pp 1-7
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
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- Cytotoxic chemotherapy
- Multi-modality treatment
- Optimal timing
- Radiation therapy
- Treatment delay
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- Author Affiliations
- 1. Center for Translational Research in Radiation Oncology, Sheba Medical Center, 52621, Tel Hashomer, Israel
- 2. Neuro-Oncology Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- 3. Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- 4. Stereotactic Radiosurgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- 5. Department of Radiation Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel