Temporal relationship of post-operative radiotherapy with temozolomide and oncologic outcome for glioblastoma Journal Article
| Authors: | Spratt, D. E.; Folkert, M.; Zumsteg, Z. S.; Chan, T. A.; Beal, K.; Gutin, P. H.; Pentsova, E.; Yamada, Y. |
| Article Title: | Temporal relationship of post-operative radiotherapy with temozolomide and oncologic outcome for glioblastoma |
| 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. © 2013 Springer Science+Business Media New York. |
| Keywords: | temozolomide; radiotherapy; glioblastoma; surgery; timing |
| Journal Title: | Journal of Neuro-Oncology |
| Volume: | 116 |
| Issue: | 2 |
| ISSN: | 0167-594X |
| Publisher: | Springer |
| Date Published: | 2014-01-01 |
| Start Page: | 357 |
| End Page: | 363 |
| Language: | English |
| DOI: | 10.1007/s11060-013-1302-4 |
| PROVIDER: | scopus |
| PUBMED: | 24190580 |
| PMCID: | PMC6683285 |
| DOI/URL: | |
| Notes: | Export Date: 3 March 2014 -- CODEN: JNODD -- Source: Scopus |
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