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J Neurol Surg A Cent Eur Neurosurg 2022; 83(03): 252-258
DOI: 10.1055/s-0041-1730965
Original Article

The Role of Delayed Radiotherapy Initiation in Patients with Newly Diagnosed Glioblastoma with Residual Tumor Mass

Johannes Kasper 
1   Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
,
Clara Frydrychowicz
2   Department of Neuropathology, University Hospital Leipzig, Leipzig, Sachsen, Germany
,
Katja Jähne
1   Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
,
Tim Wende
1   Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
,
Florian Wilhelmy
1   Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
,
Felix Arlt
1   Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
,
Clemens Seidel
3   Department of Radio-Oncology, University Hospital Leipzig, Leipzig, Sachsen, Germany
,
Karl-Titus Hoffmann
4   Department of Neuro-Radiology, University Hospital Leipzig, Leipzig, Sachsen, Germany
,
Jürgen Meixensberger
1   Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
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Abstract

Objective Treatment for newly diagnosed isocitrate dehydrogenase (IDH) wild-type glioblastoma (GBM) includes maximum safe resection, followed by adjuvant radio(chemo)therapy (RCx) with temozolomide. There is evidence that it is safe for GBM patients to prolong time to irradiation over 4 weeks after surgery. This study aimed at evaluating whether this applies to GBM patients with different levels of residual tumor volume (RV).

Methods Medical records of all patients with newly diagnosed GBM at our department between 2014 and 2018 were reviewed. Patients who received adjuvant radio (chemo) therapy, aged older than 18 years, and with adequate perioperative imaging were included. Initial and residual tumor volumes were determined. Time to irradiation was dichotomized into two groups (≤28 and >28 days). Univariate analysis with Kaplan–Meier estimate and log-rank test was performed. Survival prediction and multivariate analysis were performed employing Cox proportional hazard regression.

Results One hundred and twelve patients were included. Adjuvant treatment regimen, extent of resection, residual tumor volume, and O6-methylguanine DNA methyltransferase (MGMT) promoter methylation were statistically significant factors for overall survival (OS). Time to irradiation had no impact on progression-free survival (p = 0.946) or OS (p = 0.757). When stratified for different thresholds of residual tumor volume, survival predication via Cox regression favored time to irradiation below 28 days for patients with residual tumor volume above 2 mL, but statistical significance was not reached.

Conclusion Time to irradiation had no significant influence on OS of the entire cohort. Nevertheless, a statistically nonsignificant survival prolongation could be observed in patients with residual tumor volume > 2 mL when admitted to radiotherapy within 28 days after surgery.

Keywords

glioblastoma - radio-chemotherapy - radiotherapy - residual tumor volume

Ethical Approval

Data collection and analysis were approved by the ethical committee of the Medical Faculty, University of Leipzig, and performed in accordance with data protection guidelines (144/08-ek). Informed consent for retrospective data analysis was obtained from all patients treated in the Neurosurgical Department of Leipzig University.


Availability of Supporting Data

Data and material are available from the corresponding author upon reasonable request.


Supplementary Material



Publication History

Received: 11 August 2020

Accepted: 16 December 2020

Article published online:
08 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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