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Temporal relationship of post-operative radiotherapy with temozolomide and oncologic outcome for glioblastoma

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Abstract

To determine the impact of delay between surgery and radiotherapy on overall survival (OS) in temozolomide treatmented patients with the incorporation of O6-methylguanine–DNA methyltransferase (MGMT). From 2000 to 2012, 345 consecutive glioblastoma patients were treated with surgery, radiotherapy, and temozolomide at our institution. A Cox-regression model was constructed using significant univariate parameters, known prognostic factors including MGMT, and the interval from surgery to radiotherapy (≤2, 2–5, and ≥6 weeks). Survival rates were calculated by Kaplan–Meier methods. Cox-regression was utilized to calculate adjusted hazard ratios (HR). The median survival for the entire cohort was 12.2 months. The 1 year actuarial OS was 43.1 %, 53.3 %, and 64.3 % (p = 0.11), for intervals from surgery to radiotherapy of ≤2, 2–5, and ≥6 weeks, respectively. Patients radiated within 2 weeks post-surgery were more likely to have older age (p = 0.03), treated with 2D techniques (p < 0.001) and dose <36 Gy (p < 0.001), undergo a biopsy only (p < 0.001), KPS of <70 (p < 0.001), severe pre-radiotherapy neurologic symptoms (p = 0.04), and bilateral disease (p = 0.02). Multivariate analysis including MGMT status demonstrated a significant detriment in delaying radiotherapy (≤2 weeks as reference); 3–5 weeks (HR 2.80 [0.72–10.89], p = 0.14), and >6 weeks (HR 3.76 [1.01–14.57], p = 0.05). We report the first analysis on the survival impact of delaying post-operative radiotherapy for temozolomide treated glioblastoma patients with MGMT information. Our data does not support the OS benefit previously seen in delayed RT when correcting for important covariates. We demonstrate a survival detriment with delaying RT post-surgery greater than 6 weeks on multivariate analysis.

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Acknowledgments

Dr. Yamada is a Consultant for Varian Medical Systems, Inc. and a member of the Speakers Bureau for the Institute for Medical Education; the other authors have no financial disclosures or conflicts of interest to report.

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Authors and Affiliations

  1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 22, New York, NY, 10065, USA

    Daniel E. Spratt, Michael Folkert, Zachary S. Zumsteg, Timothy A. Chan, Kathryn Beal & Yoshiya Yamada

  2. Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Philip H. Gutin

  3. Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Elena Pentsova

Authors
  1. Daniel E. Spratt
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  2. Michael Folkert
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  3. Zachary S. Zumsteg
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  4. Timothy A. Chan
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  5. Kathryn Beal
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  6. Philip H. Gutin
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  7. Elena Pentsova
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  8. Yoshiya Yamada
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Corresponding author

Correspondence to Yoshiya Yamada.

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Daniel E. Spratt and Michael Folkert have contributed equally to this study.

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Spratt, D.E., Folkert, M., Zumsteg, Z.S. et al. Temporal relationship of post-operative radiotherapy with temozolomide and oncologic outcome for glioblastoma. J Neurooncol 116, 357–363 (2014). https://doi.org/10.1007/s11060-013-1302-4

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  • DOI: https://doi.org/10.1007/s11060-013-1302-4

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