Impact of time to initiation of radiotherapy on survival after resection of newly diagnosed glioblastoma
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RESEARCH
Open Access
Impact of time to initiation of radiotherapy on survival after resection of newly diagnosed glioblastoma Sotirios Katsigiannis1*, Boris Krischek2, Stefanie Barleanu2, Stefan Grau2, Norbert Galldiks3,4,5, Marco Timmer2, Christoph Kabbasch6, Roland Goldbrunner2 and Pantelis Stavrinou2
Abstract Background and purpose: To evaluate the effect of timing of radiotherapy (RT) on survival in patients with newly diagnosed primary glioblastoma (GBM) treated with the same therapeutical protocol. Materials and methods: Patients with newly diagnosed primary GBM treated with the same therapeutical scheme between 2010 and 2015 in our institution were retrospectively reviewed. The population was trichotomized based on the time interval from surgery till initiation of RT (< 28 days, 28–33 days, > 33 days). Kaplan-Meier and Cox regression analyses were used to compare progression free survival (PFS) and overall survival (OS) between the groups. The influence of various extensively studied prognostic factors on survival was assessed by multivariate analysis. Results: One-hundred-fifty-one patients met the inclusion criteria. Between the three groups no significant difference in PFS (p = 0.516) or OS (p = 0.902) could be demonstrated. Residual tumor volume (RTV) and midline structures involvement were identified as independent prognostic factors of PFS while age, O-6-Methylguanine Methyltransferase (MGMT) status, Ki67 index, RTV and midline structures involvement represented independent predictors of OS. Patients starting RT after a prolonged delay (> 48 days) exhibited a significantly shorter OS (p = 0.034). Conclusion: Initiation of RT within a timeframe of 48 days is not associated with worsened survival. A prolonged delay (> 48 days) may be associated with worse OS. RT should neither be delayed, nor forced, but should rather start timely, as soon as the patient has recovered from surgery. Keywords: Glioblastoma, Timing of radiotherapy, Prognostic factors, Survival, Progression free survival
Introduction Glioblastoma (GBM) is both the most common and lethal primary brain tumor in adults [1, 2]. The standard of care for patients with newly diagnosed GBM comprises maximum safe resection of the tumor followed by radiotherapy (RT) with concomitant and adjuvant temozolomide (TMZ) chemotherapy [3, 4]. Despite this multimodal therapeutical approach, the median overall survival time is approximately 15–17 months [5, 6]. Extensively studied prognostic factors of survival include age, Karnofsky Performance Score (KPS), extent of tumor resection (EOR), residual tumor volume (RTV), * Correspondence: [email protected] 1 Department of Neurosurgery, University Hospital of Bochum, In der Schornau Str. 23-25, 44892 Bochum, Germany Full list of author information is available at the end of the article
O-6-Methylguanine Methyltransferase (MGMT) promoter methylation status, and Ki-67 expression [7–12]. The impact of timing of RT initiation on survival after surgical resection remains controversial [13–18]. From a bi
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