Delay in starting radiotherapy due to neoadjuvant therapy does not worsen survival in unresected glioblastoma patients

Abstract

Purpose

We retrospectively examined the potential effect on overall survival (OS) of delaying radiotherapy to administer neoadjuvant therapy in unresected glioblastoma patients.

Patients and methods

We compared OS in 119 patients receiving neoadjuvant therapy followed by standard treatment (NA group) and 96 patients receiving standard treatment without neoadjuvant therapy (NoNA group). The MaxStat package of R identified the optimal cut-off point for waiting time to radiotherapy.

Results

OS was similar in the NA and NoNA groups. Median waiting time to radiotherapy after surgery was 13 weeks for the NA group and 4.2 weeks for the NoNA group. The longest OS was attained by patients who started radiotherapy after 12 weeks and the shortest by patients who started radiotherapy within 4 weeks (12.3 vs 6.6 months) (P = 0.05). OS was 6.6 months for patients who started radiotherapy before the optimal cutoff of 6.43 weeks and 19.1 months for those who started after this time (P = 0.005). Patients who completed radiotherapy had longer OS than those who did not, in all 215 patients and in the NA and NoNA groups (P = 0.000). In several multivariate analyses, completing radiotherapy was a universally favorable prognostic factor, while neoadjuvant therapy was never identified as a negative prognostic factor.

Conclusion

In our series of unresected patients receiving neoadjuvant treatment, in spite of the delay in starting radiotherapy, OS was not inferior to that of a similar group of patients with no delay in starting radiotherapy.

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Funding

This work was supported by Fundació La Marató TV3 (665/C/2013) (http://www.ccma.cat/tv3/marato/projectes-financats/2012/231/) and a Grant of the Spanish Instituto Carlos III (FISS-ICIII: project EC08/00071). Financial support and logistics assistance for the study GENOM 008 study were provided by Pfizer and for the GENOM 009 study by Roche and MSD. The funding bodies were not involved in patient recruitment, data collection, data interpretation, or the decision to publish. The corresponding author assumes all responsibility for the data.

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Correspondence to C. Balaña.

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Carmen Balaña declares an advisory position for AbbVie and Amgen and financial support for attending symposia of Pharmamar. The remaining authors declare that they have no conflict of interest.

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The studies were approved by the Ethics Committee of each participating hospital.

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Written informed consent was obtained from all patients before registration in trials/projects of the GEINO and GLIOCAT groups.

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Balaña, C., Estival, A., Teruel, I. et al. Delay in starting radiotherapy due to neoadjuvant therapy does not worsen survival in unresected glioblastoma patients. Clin Transl Oncol 20, 1529–1537 (2018). https://doi.org/10.1007/s12094-018-1883-7

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Keywords

  • Glioblastoma
  • Neoadjuvant
  • Unresected
  • Radiotherapy delay
  • MGMT
  • Prognosis
  • Glioblastoma
  • Neoadjuvant therapy
  • Waiting time to radiotherapy
  • Overall survival