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The Potential Impact of Delayed Radiation Therapy on Patients with Glioblastoma

Published online by Cambridge University Press:  23 September 2014

Ibrahim Alnaami ,
Juliana VanderPluym ,
Albert Murtha ,
Simon Walling ,
Vivek Mehta ,
Sita Gourishankar  and
Ambikaipakan Senthilselvan
Ibrahim Alnaami*
Affiliation:
Division of Neurosurgery, University of Alberta, Edmonton, Alberta Division of Neurosurgery, Department of Surgery, King Khalid University, Abha, Saudi Arabia
Juliana VanderPluym
Affiliation:
Department of Surgery, Department of Pediatric Neurology, University of Alberta, Edmonton, Alberta
Albert Murtha
Affiliation:
Division of Radiation Oncology, University of Alberta, Edmonton, Alberta
Simon Walling
Affiliation:
Department of Oncology, Department of Medicine, University of Alberta, Edmonton, Alberta
Vivek Mehta
Affiliation:
Department of Public Health Sciences, University of Alberta, Edmonton, Alberta
Sita Gourishankar
Affiliation:
Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia
Ambikaipakan Senthilselvan
Affiliation:
Department of Surgery, Dalhousie University, Halifax, Nova Scotia
*
Neurosurgery Division, 2D2.01 Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street, Edmonton, Alberta, T6G 2b7, Canada. Email: ialnaami@ualberta.ca
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Abstract

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Background:

Radiation therapy (RT) is the major component of glioblastoma treatment; however, the time to initiate RT after surgical intervention varies between institutions. Our study examined the time from diagnosis to the initiation of RT and its effects on overall patient survival.

Methods:

We retrospectively examined 267 patients with glioblastoma who received RT as part of their therapy in two Canadian tertiary care centers. The primary goal of the study is to assess if time to RT can predict/impact survival in glioblastoma patients.

Results:

The following variables were associated with an increased risk of death: hazard ratio (HR) of time to RT was 0.95 [95% confidence interval (CI), 0.91–0.99] for every extra week. HRs for the type of surgery (resection or biopsy) and type of management received (standard of care in comparison with RT regardless of chemotherapeutic agents other than concomitant and adjuvant temozolomide) were 0.50 (95% CI, 0.37–0.66) and 0.53 (95% CI, 0.38–0.75), respectively. HR for age was 1.02 (95% CI, 1.01–1.03) for every extra year. Standard 60 Gy RT HR was 0.70 [95% confidence interval (CI), 0.51–0.97] in younger patients.

Conclusions:

The time from diagnosis to the initiation of RT was found to be a significant prognostic factor for overall patient survival. The addition of temozolomide to the treatment protocol, age, standard RT dose in younger patients and extent of surgery are others factors associated with longer survival periods.

Résumé

RÉSUMÉContexte:

La radiothérapie (RT) est l'élément le plus important du traitement du glioblastome. Cependant, le moment du début de la RT après la chirurgie varie selon les institutions. Le but de l'étude était d'examiner le temps écoulé à partir du moment où le diagnostic a été posé jusqu'au moment où la RT a été commencée et ses effets sur la survie globale des patients.

Méthode:

Nous avons effectué une revue rétrospective de cohorte de tous les patients traités par SG pour une récidive focale d'un gliome de haut grade dans notre institution entre novembre 2003 et avril 2013. Nous avons recueilli les informations sur l'âge, le sexe, le volume de la tumeur, sa localisation et son diamètre maximal, l'état clinique du patient au moment de la consultation initiale, les complications et l'issue clinique.

Résultats:

Les variables suivantes étaient associées à un risque accru de décès : le rapport de risque (RR) du temps écoulé jusqu'à la RT était de 0,95 (intervalle de confiance (IC) à 95% : 0,91 à 0,99) pour chaque semaine supplémentaire. Les RR pour le type de chirurgie (résection ou biopsie) et le type de traitement reçu (traitement standard par rapport à la RT, indépendamment des antinéoplasiques autres que le témozolomide administré de façon concomitante et comme adjuvant) étaient 0,50 (IC à 95% : 0,37 à 0,75) et 0,53 (IC à 95% : 0,38 à 0,75) respectivement. Le RR pour l'âge était 1,02 (IC à 95% : 1,01 à 1,03) pour chaque année additionnelle. Le RR pour la RT à dose standard (60 Gy) était 0,70 (IC à 95% : 0,51 à 0,97) chez les patients plus jeunes.

Conclusions:

Le temps écoulé du diagnostic au début de la RT était un facteur de prédiction significatif de la survie globale du patient. L'ajout du témozolomide au protocole de traitement, l'âge, la dose standard de RT chez les patients plus jeunes et l'étendue de la chirurgie sont d'autres facteurs associés à une survie plus longue.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 6 , November 2013 , pp. 790 - 794
Copyright
Copyright © The Canadian Journal of Neurological 2013

References

1. Stupp, R, Dietrich, PY, Ostermann Kraljevic, S, et al. Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol. 2002;20(5):1375–82.CrossRefGoogle ScholarPubMed
2. Darefsky, AS, King, JT Jr., Dubrow, R. Adult glioblastoma multiforme survival in the temozolomide era: a population-based analysis of Surveillance, Epidemiology, and End Results registries. Cancer. 2012;118(8):21630–72.CrossRefGoogle Scholar
3. Gerstein, J, Franz, K, Steinbach, JP, Seifert, V, Rodel, C, Weiss, C. Radiochemotherapy with temozolomide for patients with glioblastoma. Prognostic factors and long-term outcome of unselected patients from a single institution. Strahlenther Onkol. 2011;187(11):722–8.Google Scholar
4. Lawrence, YR, Blumenthal, DT, Matceyevsky, D, Kanner, AA, Bokstein, F, Corn, BW. Delayed initiation of radiotherapy for glioblastoma: how important is it to push to the front (or the back) of the line? J Neurooncol. 2011;105(1):1–7.CrossRefGoogle Scholar
5. McGirt, MJ, Chaichana, KL, Gathinji, M, et al. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg. 2009;110(1):156–62.CrossRefGoogle ScholarPubMed
6. Keime-Guibert, F, Chinot, O, Taillandier, L, et al. Radiotherapy for glioblastoma in the elderly. N Engl J Med. 2007;356(15):1527–35.CrossRefGoogle ScholarPubMed
7. 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. Cancer. 1981;47 (4):649–52.Google Scholar
8. Walker, MD, Alexander, E Jr., Hunt, WE, et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg. 1978;49(3):333–43.CrossRefGoogle ScholarPubMed
9. Blumenthal, DT, Won, M, Mehta, MP, et al. 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. 2009;27(5):733–9.CrossRefGoogle Scholar
10. Do, V, Gebski, V, Barton, MB. The effect of waiting for radiotherapy for grade III/IV gliomas. Radiother Oncol. 2000;57(2):131–6.Google Scholar
11. Irwin, C, Hunn, M, Purdie, G, Hamilton, D. Delay in radiotherapy shortens survival in patients with high grade glioma. J Neurooncol. 2007;85(3):339–43.CrossRefGoogle ScholarPubMed
12. Lai, R, Hershman, DL, Doan, T, Neugut, AI. The timing of cranial radiation in elderly patients with newly diagnosed glioblastoma multiforme. Neurooncol. 2010;12(2):190–8.Google Scholar
13. Chen, Z, King, W, Pearcey, R, Kerba, M, Mackillop, WJ. The relationship between waiting time for radiotherapy and clinical outcomes: A systematic review of the literature. Radiother Oncol. 2008;87(1):3–16.CrossRefGoogle ScholarPubMed
14. Randomized trial of procarbazine, lomustine, and vincristine in the adjuvant treatment of high-grade astrocytoma: a Medical Research Council trial. J Clin Oncol. 2001;19(2):509–18.CrossRefGoogle Scholar
15. Roa, W, Brasher, PM, Bauman, G, et al. Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol. 2004;22 (9):1583–8.CrossRefGoogle ScholarPubMed
16. Lawrence, YR, Mishra, MV, Werner-Wasik, M, et al. Improving prognosis of glioblastoma in the 21st century: who has benefited most? Cancer. 2012;118(17):4228–34.CrossRefGoogle Scholar
17. Wehming, FM, Wiese, B, Nakamura, M, Bremer, M, Karstens, JH, Meyer, A. Malignant glioma grade 3 and 4: how relevant is timing of radiotherapy? Clin Neurol Neurosurg. 2012;114(6):617–21.CrossRefGoogle ScholarPubMed
18. Burnet, NG, Jena, R, Jefferies, SJ, Stenning, SP, Kirkby, NF. Mathematical modelling of survival of glioblastoma patients suggests a role for radiotherapy dose escalation and predicts poorer outcome after delay to start treatment. Clin Oncol (R Coll Radiol). 2006;18(2):93–103.CrossRefGoogle ScholarPubMed
19. Burger, PC, Green, SB. Patient age, histologic features, and length of survival in patients with glioblastoma multiforme. Cancer. 1987; 59(9):1617–25.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
20. Lawrence, YR, Mishra, MV, Werner-Wasik, M, et al. Improving prognosis of glioblastoma in the 21st century: who has benefited most? Cancer. 2012;118(17):4228–34.CrossRefGoogle Scholar
21. Hulshof, MC, Koot, RW, Schimmel, EC, Dekker, F, Bosch, DA, Gonzalez Gonzalez, D. Prognostic factors in glioblastoma multiforme. 10 years experience of a single institution. Strahlenther Onkol. 2001;177(6):283–90.CrossRefGoogle ScholarPubMed
22. Mason, WP, Maestro, RD, Eisenstat, D, et al. Canadian recommendations for the treatment of glioblastoma multiforme. Curr Oncol. 2007;14(3):110–17.Google Scholar
23. Stupp, R, Mason, WP, van den Bent, MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987–96.Google Scholar
24. Li, J, Wang, M, Won, M, et al. Validation and simplification of the Radiation Therapy Oncology Group recursive partitioning analysis classification for glioblastoma. Int J Radiat Oncol Biol Phys. 2011;81(3):623–30.Google Scholar
25. Ozbek, N, Cakir, S, Gursel, B, Meydan, D. Prognostic significance of seizure in patients with glioblastoma multiforme. Neurol India. 2004;52(1):76–8.Google Scholar