Advertisement

Clinical and Translational Oncology

, Volume 15, Issue 4, pp 278–282 | Cite as

Impact of radiotherapy delay on survival in glioblastoma

  • Izaskun ValduviecoEmail author
  • Eugènia Verger
  • Jordi Bruna
  • Lluís Caral
  • Teresa Pujol
  • Teresa Ribalta
  • Teresa Boget
  • Laura Oleaga
  • Estela Pineda
  • Francesc Graus
Research Article

Abstract

Background

Previous studies in glioblastoma have concluded that there is no decrease in survival with increasing time to initiation of RT up to 6 weeks after surgery. Unfortunately, the number of glioblastoma patients who start RT beyond 6 weeks is not small in some countries. The aim of our study was to evaluate the effect of RT delay beyond 6 weeks on survival of patients who have undergone completed resection of a glioblastoma.

Methods

We reviewed 107 consecutive glioblastoma patients who had a complete surgical resection at our hospital. Clinical data, including delay in initiation of RT, were prospectively collected. The impact of single parameters on overall survival was determined by univariate and multivariate analyses.

Results

According to univariate analysis, variables that had a prognostic influence on survival were age (p = 0.036), KPS (p = 0.031), additional treatment with CHT (p < 0.0001), and initiation of RT before 42 days (p = 0.009). Multivariate analysis indicated that Karnofsky performance scale, additional treatment with chemotherapy, and initiation of RT before 6 weeks after surgery were favorable, independent prognostic factors of survival.

Conclusions

Survival is significantly reduced in glioblastoma patients if RT is not initiated within the 6 weeks after complete resection of the tumor.

Keywords

Glioblastoma Delay of radiotherapy Prognostic factors Radiotherapy 

Notes

Acknowledgments

The authors are grateful to Ms Veronica Mato for her valuable help in keeping the database updated in this research.

Conflict of interest

None declared.

References

  1. 1.
    Walker MD, Alexander E Jr, Hunt WE et al (1978) Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas: a cooperative clinical trial. J Neurosurg 49:333–343PubMedCrossRefGoogle Scholar
  2. 2.
    Huang J, Barbera L, Brouwers M, Browman G, Mackillop WJ (2003) Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 21:555–563PubMedCrossRefGoogle Scholar
  3. 3.
    Hartsell WF, Recine DC, Griem KL, Murthy AK (1995) Delaying the initiation of intact breast irradiation for patients with lymph node positive breast cancer increases the risk of local recurrence. Cancer 76:2497–2503PubMedCrossRefGoogle Scholar
  4. 4.
    Richards MA, Westcombe AM, Love SB et al (1999) Influence of delay on survival in patients with breast cancer: a systematic review. Lancet 353:1119–1126PubMedCrossRefGoogle Scholar
  5. 5.
    Buchholz TA, Austin-Seymour MM, Moe RE et al (1993) Effect of delay in radiation in the combined modality treatment of breast cancer. Int J Radiat Oncol Biol Phys 26:23–35PubMedCrossRefGoogle Scholar
  6. 6.
    Murray N, Coy P, Pater JL et al (1993) Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 11:336–344PubMedGoogle Scholar
  7. 7.
    Mackillop WJ et al (2007) Killing time: the consequences of delays in radiotherapy. Radiother Oncol 84(1):1–4PubMedCrossRefGoogle Scholar
  8. 8.
    Blumenthal DT, Won M, Mehta MP et al (2009) Short delay in initiation of radiotherapy may not affect outcome of patients with glioblastoma: a secondary analysis from the radiation therapy oncology group database. J Clin Oncol 10(27):733–739CrossRefGoogle Scholar
  9. 9.
    Bauchet L, Mathieu-Daudé H, Fabbro-Peray P et al (2010) Oncological patterns of care and outcome for 952 patients with newly diagnosed glioblastoma in 2004. Neuro Oncol 12:725–735PubMedCrossRefGoogle Scholar
  10. 10.
    Lawrence YR, Blumenthal DT, Matceyevsky D, Kanner AA, Bokstein F, Corn BW (2011) Delayed initiation of radiotherapy for glioblastoma: how important is it to push to the front (or the back) of the line? J Neurooncol 105:1–7PubMedCrossRefGoogle Scholar
  11. 11.
    Kleihues P, Cavenee WK, Scheithauer BW et al (2002) World Health Organization classification of tumours: pathology and genetics of tumours of the nervous system. J Neuropathol Exp Neurol 61:215–225PubMedGoogle Scholar
  12. 12.
    Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996PubMedCrossRefGoogle Scholar
  13. 13.
    Irwin C, Hunn M, Purdie G, Hamilton D (2007) Delay in radiotherapy shortens survival in patients with high grade glioma. J Neurooncol 85:339–343PubMedCrossRefGoogle Scholar
  14. 14.
    Peker S, Abacioglu U, Sun I, Yuksel M, Pamir MN (2004) Irradiation after surgically induced brain injury in the rat: timing in relation to severity of radiation damage. J Neurooncol 70:17–21PubMedCrossRefGoogle Scholar
  15. 15.
    Burnet NG, Jena R, Jefferies SJ, Stenning SP, Kirkby NF (2006) Mathematical modelling of survival of glioblastoma patients suggests a role for radiotherapy dose escalation and predicts poorer outcome after delay to start treatment. Clin Oncol (R Coll Radiol) 18:93–103CrossRefGoogle Scholar
  16. 16.
    Pirzkall A, McGue C, Saraswathy S et al (2009) Tumor regrowth between surgery and initiation of adjuvant therapy in patients with newly diagnosed glioblastoma. Neuro Oncol 11:842–852PubMedCrossRefGoogle Scholar
  17. 17.
    Lai R, Hershman DL, Doan T, Neugut AI (2010) The timing of cranial radiation in elderly patients with newly diagnosed glioblastoma multiforme. Neuro Oncol 12:190–198PubMedCrossRefGoogle Scholar
  18. 18.
    Darefsky AS, King JT Jr, Dubrow R (2012) Adult glioblastoma multiforme survival in the temozolomide era: a population-based analysis of surveillance, epidemiology, and end results registries. Cancer 15(118):2163–2172CrossRefGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2012

Authors and Affiliations

  • Izaskun Valduvieco
    • 1
    • 9
    Email author
  • Eugènia Verger
    • 1
  • Jordi Bruna
    • 2
  • Lluís Caral
    • 3
  • Teresa Pujol
    • 4
  • Teresa Ribalta
    • 5
  • Teresa Boget
    • 6
  • Laura Oleaga
    • 4
  • Estela Pineda
    • 7
  • Francesc Graus
    • 8
  1. 1.Radiation Oncology Service, Institute of Haematology and Oncology, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)University of BarcelonaBarcelonaSpain
  2. 2.Functional Unit of Neuro-Oncology, Department of Neurology, Hospital Universitari de Bellvitge-ICO Duran i ReynalsUniversity of BarcelonaL’HospitaletSpain
  3. 3.Neurosurgery Service, Institute of Neuroscience, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)University of BarcelonaBarcelonaSpain
  4. 4.Radiology Service, Imaging Diagnostic Center, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)University of BarcelonaBarcelonaSpain
  5. 5.Pathology Service, Biomedical Diagnostic Center, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)University of BarcelonaBarcelonaSpain
  6. 6.Neuropsychology Service, Institute of Neuroscience, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)University of BarcelonaBarcelonaSpain
  7. 7.Medical Oncology Service, Institute of Haematology and Oncology, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)University of BarcelonaBarcelonaSpain
  8. 8.Neurology Service, Institute of Neuroscience, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)University of BarcelonaBarcelonaSpain
  9. 9.Department of Radiation OncologyHospital ClinicBarcelonaSpain

Personalised recommendations