title: The influence of hyperglycemia during radiotherapy on survival in patients with primary glioblastoma.
abstract: OBJECTIVE
  Metabolism in tumor cells depends mainly on glycolysis and thus hyperglycemia has been shown to influence tumor properties in various tumor entities. In this retrospective study we set out to determine if hyperglycemic serum levels during radiation therapy impact patient survival and progression patterns in primary glioblastoma (GBM).
  
  
  METHODS
  We retrospectively analyzed glucose serum levels, survival and progression patterns on magnetic resonance imaging (MRI) in 262 GBM patients receiving radiation therapy. Hyperglycemia was classified as mild (> 180 mg/dL) or excessive (≥ 300 mg/dL), and isolated (one hyperglycemic event) or persistent (≥ 3 hyperglycemic events). The multivariate Cox proportional hazards ratio was used to assess the influence of cofactors on survival.
  
  
  RESULTS
  Persistent mild (HR = 2.23; p < 0.001) and excessive hyperglycemia (HR = 2.51; p < 0.001) were associated with a decrease in overall survival rates, even when considering the covariate corticosteroid therapy. Here metabolic imbalances did not affect the progression-free interval (p = 0.402), the occurrence of distant (p = 0.587) and multifocal progression (p = 0.445).
  
  
  CONCLUSIONS
  Our findings support the theory that hyperglycemia during radiation therapy in GBM patients is an unfavorable prognostic cofactor for survival and is detrimental to the survival rates independent of corticosteroid therapy. However, no significant effects of hyperglycemic metabolism on the progression-free interval and recurrence patterns were found.
authors.affiliation: a University Hospital of Heidelberg, Department of Radiation Oncology , Heidelberg , Germany.|b Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ) , Heidelberg , Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Adeberg
authors.affiliation: a University Hospital of Heidelberg, Department of Radiation Oncology , Heidelberg , Germany.
authors.forename: Denise
authors.initials: D
authors.lastname: Bernhardt
authors.affiliation: a University Hospital of Heidelberg, Department of Radiation Oncology , Heidelberg , Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Foerster
authors.affiliation: a University Hospital of Heidelberg, Department of Radiation Oncology , Heidelberg , Germany.|b Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ) , Heidelberg , Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Bostel
authors.affiliation: a University Hospital of Heidelberg, Department of Radiation Oncology , Heidelberg , Germany.
authors.forename: Stefan Alexander
authors.initials: SA
authors.lastname: Koerber
authors.affiliation: a University Hospital of Heidelberg, Department of Radiation Oncology , Heidelberg , Germany.|b Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ) , Heidelberg , Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Mohr
authors.affiliation: d University Hospital of Heidelberg, Department of Neuropathology , Heidelberg , Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Koelsche
authors.affiliation: a University Hospital of Heidelberg, Department of Radiation Oncology , Heidelberg , Germany.|b Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ) , Heidelberg , Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rieken
authors.affiliation: a University Hospital of Heidelberg, Department of Radiation Oncology , Heidelberg , Germany.|b Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ) , Heidelberg , Germany.|c Heidelberg Ion-Beam Therapy Center (HIT) , Heidelberg , Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Debus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D001932:Brain Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000401:mortality* / Q000532:radiotherapy*; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology* / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D001786:Blood Glucose