Skip to main content
SpringerLink
Log in

Demographic variations and time to initiation of adjunct treatment following surgical resection of anaplastic astrocytoma in the United States: a National Cancer Database analysis

  • Research
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Background and aims

The aim of this study was to analyze the trends, demographic differences in the type and time to initiation (TTI) of adjunct treatment AT following surgery for anaplastic astrocytoma (AA).

Material and methods

The National Cancer Database (NCDB) was queried for patients diagnosed with AA from 2004 to 2016. Cox proportional hazards and modeling was used to determine factors influencing survival, including the impact of time to initiation (TTI) of adjuvant therapy.

Results

Overall, 5890 patients were identified from the database. The use of combined RT + CT temporally increased from 66.3% (2004–2007) to 79% (2014–2016), p < 0001. Patients more likely to receive no treatment following surgical resection included elderly (> 60 years old), hispanic patients, those with either no or government insurance, those living > 20 miles from the cancer facility, those treated at low volume centers (< 2 cases/year). AT was received following surgical resection within 0–4 weeks, 4.1–8 weeks, and > 8 weeks in 41%, 48%, and 3%, respectively. Compared to patients who received RT + CT, patients were likely to receive RT only as AT either at 4–8 weeks or > 8 weeks after the surgical procedure. Patients who received AT within 0–4 weeks had the 3-year OS of 46% compared to 56.7% for patients who received treatment at 4.1–8 weeks.

Conclusion

We found significant variation in the type and timing of adjunct treatment following surgical resection of AA in the United States. A considerable number of patients (15%) received no AT following surgery.

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

References

  1. Smoll NR, Hamilton B (2014) Incidence and relative survival of anaplastic astrocytomas. Neuro Oncol 16:1400–1407

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y et al (2013) CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2006–2010. Neuro Oncol 15 Suppl 2:ii1–56

  3. Kosztyla R, Chan EK, Hsu F, Wilson D, Ma R, Cheung A et al (2013) High-grade glioma radiation therapy target volumes and patterns of failure obtained from magnetic resonance imaging and 18F-FDOPA positron emission tomography delineations from multiple observers. Int J Radiat Oncol Biol Phys 87:1100–1106

    Article  PubMed  Google Scholar 

  4. Pedicini P, Fiorentino A, Simeon V, Tini P, Chiumento C, Pirtoli L et al (2014) Clinical radiobiology of glioblastoma multiforme: estimation of tumor control probability from various radiotherapy fractionation schemes. Strahlenther Onkol 190:925–932

    Article  PubMed  Google Scholar 

  5. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996

    Article  CAS  PubMed  Google Scholar 

  6. Do V, Gebski V, Barton MB (2000) The effect of waiting for radiotherapy for grade III/IV gliomas. Radiother Oncol 57:131–136

    Article  CAS  PubMed  Google Scholar 

  7. Irwin C, Hunn M, Purdie G, Hamilton D (2007) Delay in radiotherapy shortens survival in patients with high grade glioma. J Neurooncol 85:339–343

    Article  PubMed  Google Scholar 

  8. Stupp R, Taillibert S, Kanner A, Read W, Steinberg DM, Lhermitte B et al (2017) Effect of tumor-treating fields plus maintenance temozolomide vs maintenance temozolomide alone on survival in patients with glioblastoma: a randomized clinical trial. JAMA 318:2306–2316

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Buszek SM, Al Feghali KA, Elhalawani H, Chevli N, Allen PK, Chung C (2020) Optimal timing of radiotherapy following gross total or subtotal resection of glioblastoma: a real-world assessment using the national cancer database. Sci Rep 10:4926

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Barnholtz-Sloan JS, Sloan AE, Schwartz AG (2003) Racial differences in survival after diagnosis with primary malignant brain tumor. Cancer 98:603–609

    Article  PubMed  Google Scholar 

  11. Ostrom QT, Krebs HL, Patil N, Cioffi G, Barnholtz-Sloan JS (2021) Racial/ethnic disparities in treatment pattern and time to treatment for adults with glioblastoma in the US. J Neurooncol 152:603–615

    Article  PubMed  Google Scholar 

  12. Bilimoria KY, Stewart AK, Winchester DP, Ko CY (2008) The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 15:683–690

    Article  PubMed  PubMed Central  Google Scholar 

  13. Yadav K, Lewis RJ (2021) Immortal time bias in observational studies. JAMA 325:686–687

    Article  PubMed  Google Scholar 

  14. Grambsch PM, Therneau TM (1994) Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81:515–526

    Article  Google Scholar 

  15. Paul HCE, Marx BD (1996) Flexible smoothing with $B$-splines and penalties. Stat Sci 11:89–102

    Google Scholar 

  16. Team RC: R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. http://www.R-project.org/, 2013

  17. Pignatti F, van den Bent M, Curran D, Debruyne C, Sylvester R, Therasse P et al (2002) Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol 20:2076–2084

    Article  PubMed  Google Scholar 

  18. Brat DJ (2012) Glioblastoma: biology, genetics, and behavior. Am Soc Clin Oncol Educ Book 32:102–107

    Article  Google Scholar 

  19. Shin JY, Diaz AZ (2016) Anaplastic astrocytoma: prognostic factors and survival in 4807 patients with emphasis on receipt and impact of adjuvant therapy. J Neurooncol 129:557–565

    Article  CAS  PubMed  Google Scholar 

  20. Shin JY, Yoon JK, Diaz AZ (2017) Influence of insurance status and income in anaplastic astrocytoma: an analysis of 4325 patients. J Neurooncol 132:89–98

    Article  PubMed  Google Scholar 

  21. Ryckman JM, Surkar SM, Haque W, Butler EB, Teh BS, Verma V (2019) Sequencing of chemotherapy and radiotherapy for newly diagnosed anaplastic oligodendroglioma and oligoastrocytoma. Am J Clin Oncol 42:258–264

    Article  PubMed  Google Scholar 

  22. Jacobs CD, Carpenter DJ, Hong JC, Havrilesky LJ, Sosa JA, Chino JP (2019) Radiation records in the National Cancer Database: variations in coding and/or practice can significantly alter survival results. JCO Clin Cancer Inform 3:1–9

    PubMed  Google Scholar 

  23. Yang DX, Khera R, Miccio JA, Jairam V, Chang E, James BY et al (2021) Prevalence of missing data in the National Cancer Database and association with overall survival. JAMA Netw Open 4:e211793–e211793

    Article  PubMed  PubMed Central  Google Scholar 

  24. Haque W, Thong E, Andrabi S, Verma V, Butler EB, Teh BS (2021) Prognostic and predictive impact of MGMT promoter methylation in grade 3 gliomas. J Clin Neurosci 85:115–121

    Article  CAS  PubMed  Google Scholar 

  25. Blumenthal DT, Won M, Mehta MP, Curran WJ, Souhami L, Michalski JM 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 27:733–739

    Article  PubMed  Google Scholar 

  26. 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 105:1–7

    Article  CAS  PubMed  Google Scholar 

  27. Loureiro LV, Victor Eda S, Callegaro-Filho D, Koch Lde O, Pontes Lde B, Weltman E et al (2016) Minimizing the uncertainties regarding the effects of delaying radiotherapy for Glioblastoma: a systematic review and meta-analysis. Radiother Oncol 118:1–8

    Article  PubMed  Google Scholar 

  28. Wang TJ, Jani A, Estrada JP, Ung TH, Chow DS, Soun JE et al (2016) Timing of adjuvant radiotherapy in glioblastoma patients: a single-institution experience with more than 400 patients. Neurosurgery 78:676–682

    Article  PubMed  Google Scholar 

  29. Cairncross G, Wang M, Shaw E, Jenkins R, Brachman D, Buckner J et al (2013) Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol 31:337

    Article  CAS  PubMed  Google Scholar 

  30. Lassman AB, Hoang-Xuan K, Polley M-YC, Brandes AA, Cairncross JG, Kros JM et al (2022) Joint final report of EORTC 26951 and RTOG 9402: phase III trials with procarbazine, lomustine, and vincristine chemotherapy for anaplastic oligodendroglial tumors. J Clin Oncol 40:2539–2545

    Article  CAS  PubMed  Google Scholar 

  31. Louis DN, Perry A, Wesseling P, Brat DJ, Cree IA, Figarella-Branger D et al (2021) The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro Oncology 23:1231–1251

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. van den Bent MJ, Tesileanu CMS, Wick W, Sanson M, Brandes AA, Clement PM et al (2021) Adjuvant and concurrent temozolomide for 1p/19q non-co-deleted anaplastic glioma (CATNON; EORTC study 26053–22054): second interim analysis of a randomised, open-label, phase 3 study. Lancet Oncol 22:813–823

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, 40202, USA

    Mayur Sharma, Akshitkumar M. Mistry & Brian J. Williams

  2. Department of Neurosurgery, University of Minnesota, MMC 96, 420 Delaware St. SE, Minneapolis, MN, 55455, USA

    Mayur Sharma

  3. Department of Radiation Oncology, University of Louisville Hospital, Louisville, KY, USA

    Grant W. McKenzie & Shiao Woo

  4. Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA

    Jeremy Gaskins

  5. Department of Radiation Oncology, University of Alabama, Birmingham, AL, 35233, USA

    Mehran Yusuf

Authors
  1. Mayur Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Grant W. McKenzie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeremy Gaskins
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mehran Yusuf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shiao Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akshitkumar M. Mistry
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Brian J. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M.S., G.M.: Wrote the main manuscript J.G: extracted the data and did statistical analysis M.Y, S.W, A.M, B.W: Critically reviewed the manuscript All authors reviewed the manuscript

Corresponding author

Correspondence to Mayur Sharma.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

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

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 782 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, M., McKenzie, G.W., Gaskins, J. et al. Demographic variations and time to initiation of adjunct treatment following surgical resection of anaplastic astrocytoma in the United States: a National Cancer Database analysis. J Neurooncol 162, 199–210 (2023). https://doi.org/10.1007/s11060-023-04286-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-023-04286-7

Keywords

Search

Navigation