Journal of Neuro-Oncology

, Volume 105, Issue 1, pp 1–7

Delayed initiation of radiotherapy for glioblastoma: how important is it to push to the front (or the back) of the line?

  • Yaacov Richard Lawrence
  • Deborah T. Blumenthal
  • Diana Matceyevsky
  • Andrew A. Kanner
  • Felix Bokstein
  • Benjamin W. Corn
Topic Review

DOI: 10.1007/s11060-011-0589-2

Cite this article as:
Lawrence, Y.R., Blumenthal, D.T., Matceyevsky, D. et al. J Neurooncol (2011) 105: 1. doi:10.1007/s11060-011-0589-2

Abstract

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.

Keywords

Cytotoxic chemotherapyMulti-modality treatmentOptimal timingRadiation therapyTreatment delay

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Yaacov Richard Lawrence
    • 1
  • Deborah T. Blumenthal
    • 2
  • Diana Matceyevsky
    • 3
  • Andrew A. Kanner
    • 4
  • Felix Bokstein
    • 2
  • Benjamin W. Corn
    • 5
  1. 1.Center for Translational Research in Radiation OncologySheba Medical CenterTel HashomerIsrael
  2. 2.Neuro-Oncology ServiceTel Aviv Sourasky Medical CenterTel AvivIsrael
  3. 3.Division of OncologyTel Aviv Sourasky Medical CenterTel AvivIsrael
  4. 4.Stereotactic Radiosurgery Unit, Department of NeurosurgeryTel Aviv Sourasky Medical CenterTel AvivIsrael
  5. 5.Department of Radiation OncologyTel Aviv Sourasky Medical CenterTel AvivIsrael