Skip to main content
SpringerLink
Log in

Timing of radiotherapy in glioblastoma based on IMRT and STUPP chemo-radiation: may be no need to rush

  • Research Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Objective

To investigate the effect of surgery to radiotherapy interval (SRI) on the prognosis of patients with isocitrate dehydrogenase (IDH) wild-type glioblastoma.

Methods

Retrospective analysis of the relationship between SRI and prognosis of patients with IDH wild-type glioblastoma who received postoperative intensity modulated radiotherapy (IMRT) in our center from July 2013 to July 2019. The patients were divided into SRI ≤ 42 days (regular group) and SRI > 42 days (delay group). Kaplan–Meier univariate analysis and Cox proportional hazard model were used to analyze whether SRI was an independent factor influencing the prognosis.

Results

A total of 102 IDH wild-type glioblastoma were enrolled. Median follow-up was 35.9 months. The 1-, 2- and 3-year OS of “regular group” were 69.5%, 34.8%, 19.1%, and “delay group” were 69.8%, 26.1% and 13.4% respectively. Multivariate analysis showed that extent of resection (p = 0.041) was an independent prognostic factor for OS. SRI (p = 0.347), gender (p = 0.159), age (p = 0. 921), maximum diameter (p = 0.637) MGMT promoter methylation status (P = 0.630) and ki-67 expression (P = 0.974) had no effect on OS. Univariate analysis (p = 0.483) and multivariate analysis (p = 0.373) also showed that SRI had no effect on OS in glioblastoma who received gross total resection.

Conclusion

Appropriate extension in SRI has no negative effect on the OS of IDH wild-type glioblastoma. It is suggested that radiotherapy should be started after a good recovery from surgery. This conclusion needs further confirmed by long-term follow-up of a large sample.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of data and materials

The data that support the findings of this study are contained in the published article.

References

  1. Louis DN, Perry A, Wesseling P, et al. The 2021 WHO classification of tumors of the central nervous system: a summary [J]. Neuro Oncol. 2021;23(8):1231–51.

    Article  CAS  Google Scholar 

  2. Delgado-Martin B, Medina MA. Advances in the knowledge of the molecular biology of glioblastoma and its impact in patient diagnosis, stratification, and treatment [J]. Adv Sci (Weinh). 2020;7(9):1902971.

    Article  CAS  Google Scholar 

  3. Jiang T, Nam DH, Ram Z, et al. Clinical practice guidelines for the management of adult diffuse gliomas [J]. Cancer Lett. 2021;499:60–72.

    Article  CAS  Google Scholar 

  4. Jiang T, Mao Y, Ma W, et al. CGCG clinical practice guidelines for the management of adult diffuse gliomas [J]. Cancer Lett. 2016;375(2):263–73.

    Article  CAS  Google Scholar 

  5. Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial [J]. Lancet Oncol. 2009;10(5):459–66.

    Article  CAS  Google Scholar 

  6. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma [J]. N Engl J Med. 2005;352(10):987–96.

    Article  CAS  Google Scholar 

  7. Fabian D, Guillermo PEM, Alnahhas I, et al. Treatment of glioblastoma (GBM) with the addition of tumor-treating fields (TTF): a review [J]. Cancers (Basel). 2019;11(2):174.

    Article  CAS  Google Scholar 

  8. Ghiaseddin AP, Shin D, Melnick K, et al. Tumor treating fields in the management of patients with malignant gliomas [J]. Curr Treat Options Oncol. 2020;21(9):76.

    Article  Google Scholar 

  9. Liu S, Shi W, Zhao Q, et al. Progress and prospect in tumor treating fields treatment of glioblastoma [J]. Biomed Pharmacother. 2021;141: 111810.

    Article  CAS  Google Scholar 

  10. Wee CW, Sung W, Kang HC, et al. Evaluation of variability in target volume delineation for newly diagnosed glioblastoma: a multi-institutional study from the Korean Radiation Oncology Group [J]. Radiat Oncol. 2015;10:137.

    Article  Google Scholar 

  11. Chang EL, Akyurek S, Avalos T, et al. Evaluation of peritumoral edema in the delineation of radiotherapy clinical target volumes for glioblastoma [J]. Int J Radiat Oncol Biol Phys. 2007;68(1):144–50.

    Article  Google Scholar 

  12. Weller M, van den Bent M, Preusser M, et al. EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood [J]. Nat Rev Clin Oncol. 2021;18(3):170–86.

    Article  Google Scholar 

  13. Wang CH, Rockhill JK, Mrugala M, et al. Prognostic significance of growth kinetics in newly diagnosed glioblastomas revealed by combining serial imaging with a novel biomathematical model[J]. Cancer Res. 2009;69(23):9133–40.

    Article  CAS  Google Scholar 

  14. Do V, Gebski V, Barton MB. The effect of waiting for radiotherapy for grade III/IV gliomas [J]. Radiother Oncol. 2000;57(2):131–6.

    Article  CAS  Google Scholar 

  15. Lai R, Hershman DL, Doan T, et al. The timing of cranial radiation in elderly patients with newly diagnosed glioblastoma multiforme [J]. Neuro Oncol. 2010;12(2):190–8.

    Article  Google Scholar 

  16. Wang TJ, Jani A, Estrada JP, et al. Timing of adjuvant radiotherapy in glioblastoma patients: a single-institution experience with more than 400 patients [J]. Neurosurgery. 2016;78(5):676–82.

    Article  Google Scholar 

  17. Sun MZ, Oh T, Ivan ME, et al. Survival impact of time to initiation of chemoradiotherapy after resection of newly diagnosed glioblastoma[J]. J Neurosurg. 2015;122(5):1144–50.

    Article  Google Scholar 

  18. Han SJ, Rutledge WC, Molinaro AM, et al. The effect of timing of concurrent chemoradiation in patients with newly diagnosed glioblastoma [J]. Neurosurgery. 2015;77(2):248–53.

    Article  Google Scholar 

  19. Pollom EL, Fujimoto DK, Han SS, et al. Newly diagnosed glioblastoma: adverse socioeconomic factors correlate with delay in radiotherapy initiation and worse overall survival [J]. J Radiat Res. 2018;59(suppl_1):i11–8.

    Article  Google Scholar 

  20. Santos VM, Marta GN, Mesquita MC, et al. The impact of the time to start radiation therapy on overall survival in newly diagnosed glioblastoma [J]. J Neurooncol. 2019;143(1):95–100.

    Article  CAS  Google Scholar 

  21. Spratt DE, Folkert M, Zumsteg ZS, et al. Temporal relationship of post-operative radiotherapy with temozolomide and oncologic outcome for glioblastoma [J]. J Neurooncol. 2014;116(2):357–63.

    Article  CAS  Google Scholar 

  22. Adeberg S, Bostel T, Harrabi S, et al. Impact of delays in initiating postoperative chemoradiation while determining the MGMT promoter-methylation statuses of patients with primary glioblastoma [J]. BMC Cancer. 2015;15:558.

    Article  Google Scholar 

  23. Niyazi M, Brada M, Chalmers AJ, et al. ESTRO-ACROP guideline “target delineation of glioblastomas” [J]. Radiother Oncol. 2016;118(1):35–42.

    Article  Google Scholar 

  24. Pouget C, Hergalant S, Lardenois E, et al. Ki-67 and MCM6 labeling indices are correlated with overall survival in anaplastic oligodendroglioma, IDH1-mutant and 1p/19q-codeleted: a multicenter study from the French POLA network [J]. Brain Pathol. 2020;30(3):465–78.

    Article  CAS  Google Scholar 

  25. Laperriere N, Zuraw L, Cairncross G. Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review [J]. Radiother Oncol. 2002;64(3):259–73.

    Article  Google Scholar 

  26. Kristiansen K, Hagen S, Kollevold T, et al. Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: a prospective multicenter trial of the Scandinavian Glioblastoma Study Group [J]. Cancer. 1981;47(4):649–52.

    Article  CAS  Google Scholar 

  27. Irwin C, Hunn M, Purdie G, et al. Delay in radiotherapy shortens survival in patients with high grade glioma [J]. J Neurooncol. 2007;85(3):339–43.

    Article  Google Scholar 

  28. Louis DN, Perry A, Reifenberger G, et al. The 2016 world health organization classification of tumors of the central nervous system: a summary [J]. Acta Neuropathol. 2016;131(6):803–20.

    Article  Google Scholar 

  29. Molinaro AM, Taylor JW, Wiencke JK, et al. Genetic and molecular epidemiology of adult diffuse glioma [J]. Nat Rev Neurol. 2019;15(7):405–17.

    Article  Google Scholar 

  30. Randolph DN, Mctyre ER, Paulsson AK, et al. Impact of timing of radiotherapy in patients with newly diagnosed glioblastoma [J]. Clin Neurol Neurosurg. 2016;151:73–8.

    Article  Google Scholar 

  31. Graus F, Bruna J, Pardo J, et al. Patterns of care and outcome for patients with glioblastoma diagnosed during 2008–2010 in Spain [J]. Neuro Oncol. 2013;15(6):797–805.

    Article  CAS  Google Scholar 

Download references

Funding

This work was supported by Startup Fund for scientific research, Fujian Medical University (Grant number: 2018QH1088),Fujian province Health Department Youth scientific research Funds (Grant number: 2018-01-58).

Author information

Author notes

  1. Shan Li and Feibao Guo contributed equally to this work.

Authors and Affiliations

  1. Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian Province, China

    Shan Li, Feibao Guo, Xuezhen Wang, Jiang Zeng & Jinsheng Hong

  2. Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China

    Shan Li & Jinsheng Hong

Authors
  1. Shan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Feibao Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xuezhen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiang Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jinsheng Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: SL, FG, JH; Collection and assembly of data: SL, FG, XW, JZ, Data analysis and interpretation: SL, FG; Manuscript writing: SL, FG, JH; Final approval of manuscript: All authors.

Corresponding author

Correspondence to Jinsheng Hong.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki and the Harmonized Tripartite Guideline for Good Clinical Practice from the International Conference on Harmonization.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, S., Guo, F., Wang, X. et al. Timing of radiotherapy in glioblastoma based on IMRT and STUPP chemo-radiation: may be no need to rush. Clin Transl Oncol 24, 2146–2154 (2022). https://doi.org/10.1007/s12094-022-02867-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-022-02867-y

Keywords

Search

Navigation