Impact of timing of radiotherapy in patients with newly diagnosed glioblastoma.
OBJECTIVE
To further evaluate if a delay in the start of radiation therapy (RT) affects patient outcomes for glioblastoma (GBM).


METHODS
From May 1999 to May 2010, a total of 161 patients underwent surgery followed by RT for GBM. We assessed overall survival (OS) and progression free survival (PFS), stratified by extent of surgical resection. Included in the analysis were genomic predictors of progression.


RESULTS
Median time from surgery to start of RT was 20days for biopsy alone, 28days for subtotal resection (STR) and 28days for gross total resection (GTR). For all patients, a delay >28days did not result in a difference in PFS when compared to no delay (6.7 vs. 6.9 months, p=0.07). PFS was improved in biopsy or STR patients with a >28day delay to start of RT (4.2 vs. 6.7 months, p=0.006). OS was also improved in patients receiving biopsy or STR with a >28day delay to start of RT (12.3 vs. 7.8 months, p=0.005). Multivariable analysis (MVA) demonstrated an improvement in OS and PFS with time to RT >28days for biopsy or STR patients (HR 0.52 p=0.008 and HR 0.48 p=0.02, respectively).


CONCLUSIONS
In this retrospective review of GBM patients treated at a single institution, OS and PFS were not different between time to RT >28days compared to <28 days. There was a modest improvement in both PFS and OS in patients who received biopsy or STR with time to RT >28 days.
Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States. Electronic address: dmrandolph@gmail.com.
David M
DM
Randolph
Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
Emory R
ER
McTyre
Department of Radiation Oncology, UCSF School of Medicine, San Francisco, CA, United States.
Anna K
AK
Paulsson
Department of Radiation Oncology, UNC School of Medicine, Chapel Hill, NC, United States.
Jordan A
JA
Holmes
Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
William H
WH
Hinson
Department of Internal Medicine, Section on Hematology & Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
Glenn J
GJ
Lesser
Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
Roy
R
Strowd
Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
Hui-Wen
HW
Lo
Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States; Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, United States.
Adrian W
AW
Laxton
Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
Stephen B
SB
Tatter
Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
Waldemar
W
Debinski
Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
Michael D
MD
Chan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
Delay in radiation; GBM; Glioblastoma; Radiation; Time to radiation; Time to radiation following surgery