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Survival impact of time to initiation of chemoradiotherapy after resection of newly diagnosed glioblastoma

Matthew Z. Sun Department of Neurological Surgery, University of California, San Francisco, California; and

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Taemin Oh Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois

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Michael E. Ivan Department of Neurological Surgery, University of California, San Francisco, California; and

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Aaron J. Clark Department of Neurological Surgery, University of California, San Francisco, California; and

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Michael Safaee Department of Neurological Surgery, University of California, San Francisco, California; and

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Eli T. Sayegh Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois

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Gurvinder Kaur Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois

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Andrew T. Parsa Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois

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Orin Bloch Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois

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Page Range:
1144–1150
Volume/Issue:
Volume 122: Issue 5
DOI link:
https://doi.org/10.3171/2014.9.JNS14193
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OBJECT

There are few and conflicting reports on the effects of delayed initiation of chemoradiotherapy on the survival of patients with glioblastoma. The standard of care for newly diagnosed glioblastoma is concurrent radiotherapy and temozolomide chemotherapy after maximal safe resection; however, the optimal timing of such therapy is poorly defined. Given the lack of consensus in the literature, the authors performed a retrospective analysis of The Cancer Genome Atlas (TCGA) database to investigate the effect of time from surgery to initiation of therapy on survival in newly diagnosed glioblastoma.

METHODS

Patients with primary glioblastoma diagnosed since 2005 and treated according to the standard of care were identified from TCGA database. Kaplan-Meier and multivariate Cox regression analyses were used to compare overall survival (OS) and progression-free survival (PFS) between groups stratified by postoperative delay to initiation of radiation treatment.

RESULTS

There were 218 patients with newly diagnosed glioblastoma with known time to initiation of radiotherapy identified in the database. The median duration until therapy was 27 days. Delay to radiotherapy longer than the median was not associated with worse PFS (HR = 0.918, p = 0.680) or OS (HR = 1.135, p = 0.595) in multivariate analysis when controlling for age, sex, KPS score, and adjuvant chemotherapy. Patients in the highest and lowest quartiles for delay to therapy (≤ 20 days vs ≥ 36 days) did not statistically differ in PFS (p = 0.667) or OS (p = 0.124). The small subset of patients with particularly long delays (> 42 days) demonstrated worse OS (HR = 1.835, p = 0.019), but not PFS (p = 0.74).

CONCLUSIONS

Modest delay in initiation of postoperative chemotherapy and radiation does not appear to be associated with worse PFS or OS in patients with newly diagnosed glioblastoma, while significant delay longer than 6 weeks may be associated with worse OS.

ABBREVIATIONS

CI = confidence interval; HR = hazard ratio; KPS = Karnofsky Performance Scale; OS = overall survival; PFS = progression-free survival; TCGA = The Cancer Genome Atlas.
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Contributor Notes

Correspondence Orin Bloch, Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, 676 N. St. Clair St., Ste. 2210, Chicago, IL 60611-2922. email: orin.bloch@northwestern.edu.

INCLUDE WHEN CITING Published online March 13, 2015; DOI: 10.3171/2014.9.JNS14193.

DISCLOSURE M. Z. Sun is a Howard Hughes Medical Institute Medical Research Fellow. Dr. Safaee was supported by a grant from the Doris Duke Charitable Foundation. Dr. Ivan is funded by the National Research Education Foundation through the AANS. Dr. Parsa is the Michael J. Marchese endowed chair of Neurological Surgery. Dr. Bloch is the Khatib Professor of Neurological Surgery.

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