Waiting time to radiotherapy as a prognostic factor for glioblastoma patients in a scenario of medical disparities.
OBJECTIVE
To evaluate the effect of waiting time (WT) to radiotherapy (RT) on overall survival (OS) of glioblastoma (GBM) patients as a reliable prognostic variable in Brazil, a scenario of medical disparities.


METHODS
Retrospective study of 115 GBM patients from two different health-care institutions (one public and one private) in Brazil who underwent post-operative RT.


RESULTS
Median WT to RT was 6 weeks (range, 1.3-17.6). The median OS for WT ≤ 6 weeks was 13.5 months (95%CI , 9.1-17.9) and for WT > 6 weeks was 14.2 months (95%CI, 11.2-17.2) (HR 1.165, 95%CI 0.770-1.762; p = 0.470). In the multivariate analysis, the variables associated with survival were KPS (p < 0.001), extent of resection (p = 0.009) and the adjuvant treatment (p = 0.001). The KPS interacted with WT to RT (HR 0.128, 95%CI 0.034-0.476; p = 0.002), showing that the benefit of KPS on OS depends on the WT to RT.


CONCLUSIONS
No prognostic impact of WT to RT could be detected on the OS. Although there are no data to ensure that delays to RT are tolerable, we may reassure patients that the time-length to initiate treatment does not seem to influence the control of the disease, particularly in face of other prognostic factors.
Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Luiz Victor Maia
LV
Loureiro
Departamento de Oncologia, Hospital do Coração, Sao Paulo, SP, Brazil.
Lucíola de Barros
Lde B
Pontes
Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Donato
D
Callegaro-Filho
Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Ludmila de Oliveira
Lde O
Koch
Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Eduardo
E
Weltman
Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Elivane da Silva
Eda S
Victor
Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil.
Adrialdo José
AJ
Santos
Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil.
Lia Raquel Rodrigues
LR
Borges
Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil.
Roberto Araújo
RA
Segreto
Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Suzana Maria Fleury
SM
Malheiros
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D016543:Central Nervous System Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D005260:Female; D005909:Glioblastoma / Q000401:mortality* / Q000532:radiotherapy*; D054625:Healthcare Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult