Delaying standard combined chemoradiotherapy after surgical resection does not impact survival in newly diagnosed glioblastoma patients

作者：Louvel Guillaume^*; Metellus Philippe; Noel Georges; Peeters Sophie; Guyotat Jacques; Duntze Julien; Le Reste Pierre Jean; Phong Dam Hieu; Faillot Thierry; Litre Fabien; Desse Nicolas; Petit Antoine; Emery Evelyne; Voirin Jimmy; Peltier Johann; Caire Francois; Vignes Jean Rodolphe; Barat Jean Luc; Langlois Olivier; Menei Philippe; Dumont Sarah N; Zanello Marc; Dezamis Edouard; Dhermain Frederic; Pallud Johan

来源：Radiotherapy and Oncology, 2016, 118(1): 9-15.

DOI：10.1016/j.radonc.2016.01.001

• Glioblastoma
• Standard combined chemoradiotherapy
• Time interval
• Prognostic factors
• Radiotherapy
• Temozolomide

Background: To assess the influence of the time interval between surgical resection and standard combined chemoradiotherapy on survival in newly diagnosed and homogeneously treated (surgical resection plus standard combined chemoradiotherapy) glioblastoma patients; while controlling confounding factors (extent of resection, carmustine wafer implantation, functional status, neurological deficit, and postoperative complications).
Methods: From 2005 to 2011, 692 adult patients (434 men; mean of 57.5 +/- 10.8 years) with a newly diagnosed glioblastoma were enrolled in this retrospective multicentric study. All patients were treated by surgical resection (65.5% total/subtotal resection, 34.5% partial resection; 36.7% carmustine wafer implantation) followed by standard combined chemoradiotherapy (radiotherapy at a median dose of 60 Gy, with daily concomitant and adjuvant temozolomide). Time interval to standard combined chemoradiotherapy was analyzed as a continuous variable and as a dichotomized variable using median and quartiles thresholds. Multivariate analyses using Cox modeling were conducted.
Results: The median progression-free survival was 10.3 months (95% CI, 10.0-11.0). The median overall survival was 19.7 months (95% CI, 18.5-21.0). The median time to initiation of combined chemoradiotherapy was 1.5 months (25% quartile, 1.0; 75% quartile, 2.2; range, 0.1-9.0). On univariate and multivariate analyses, OS and PFS were not significantly influenced by time intervals to adjuvant treatments. On multivariate analysis, female gender, total/subtotal resection and RTOG-RPA classes 3 and 4 were significant independent predictors of improved OS.
Conclusions: Delaying standard combined chemoradiotherapy following surgical resection of newly diagnosed glioblastoma in adult patients does not impact survival.

• 出版日期2016-1