Survival impact of prolonged postoperative radiation therapy for patients with glioblastoma treated with combined-modality therapy (original) (raw)

Abstract

Background Though conventionally fractionated chemoradiation (CRT) is well tolerated by selected patients with newly diagnosed glioblastoma (GBM), adverse health-related and nonhealth-related factors can lead to unplanned interruptions in treatment. The effects of prolonged time to completion (TTC) of radiation therapy (RT) on overall survival (OS) for these patients are unclear. Methods The National Cancer Database (NCDB) was queried for all adult patients with newly diagnosed GBM undergoing surgical resection followed by adjuvant CRT with conventionally fractionated RT (6000-6600 cGy in 30-33 fractions) from 2005 to 2012. TTC was defined as the interval from first to last fraction of RT. Recursive partitioning analysis (RPA) was used to determine a threshold for TTC of adjuvant RT. Cox proportional hazards modeling was used to identify covariates associated with OS. Results A total of 13489 patients were included in our cohort. Patients who completed adjuvant RT within the RPA-def...

Loading...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

References (25)

  1. Stupp R, Mason WP, van den Bent MJ, et al; European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glio- blastoma. N Engl J Med. 2005;352(10):987-996.
  2. Sijben AE, McIntyre JB, Roldán GB, et al. Toxicity from chemoradio- therapy in older patients with glioblastoma multiforme. J Neurooncol. 2008;89(1):97-103.
  3. Seidlitz A, Siepmann T, Löck S, Juratli T, Baumann M, Krause M. Impact of waiting time after surgery and overall time of postoperative radio- chemotherapy on treatment outcome in glioblastoma multiforme. Radiat Oncol. 2015;10:172.
  4. Ohri N, Rapkin BD, Guha D, et al. Predictors of radiation therapy non- compliance in an urban academic cancer center. Int J Radiat Oncol Biol Phys. 2015;91(1):232-238.
  5. Cox JD, Pajak TF, Asbell S, et al. Interruptions of high-dose radiation therapy decrease long-term survival of favorable patients with unresect- able non-small cell carcinoma of the lung: analysis of 1244 cases from 3 Radiation Therapy Oncology Group (RTOG) trials. Int J Radiat Oncol Biol Phys. 1993;27(3):493-498.
  6. Machtay M, Hsu C, Komaki R, et al. Effect of overall treatment time on outcomes after concurrent chemoradiation for locally advanced non-small-cell lung carcinoma: analysis of the Radiation Therapy Oncology Group (RTOG) experience. Int J Radiat Oncol Biol Phys. 2005;63(3):667-671.
  7. McMillan MT, Ojerholm E, Verma V, et al. Radiation treatment time and overall survival in locally advanced non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2017;98(5):1142-1152.
  8. Perez CA, Grigsby PW, Castro-Vita H, Lockett MA. Carcinoma of the uter- ine cervix. I. Impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy. Int J Radiat Oncol Biol Phys. 1995;32(5):1275-1288.
  9. Shaikh T, Handorf EA, Murphy CT, Mehra R, Ridge JA, Galloway TJ. The impact of radiation treatment time on survival in patients with head and neck cancer. Int J Radiat Oncol Biol Phys. 2016;96(5):967-975.
  10. Rosenthal DI, Liu L, Lee JH, et al. Importance of the treatment package time in surgery and postoperative radiation therapy for squamous car- cinoma of the head and neck. Head Neck. 2002;24(2):115-126.
  11. Bilimoria KY, Stewart AK, Winchester DP, Ko CY. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol. 2008;15(3):683-690.
  12. LeBlanc M, Crowley J. Relative risk trees for censored survival data. Biometrics. 1992;48(2):411-425.
  13. Han SJ, Rutledge WC, Molinaro AM, et al. The effect of timing of con- current chemoradiation in patients with newly diagnosed glioblastoma. Neurosurgery. 2015;77(2):248-253; discussion 253.
  14. Wang TJ, Jani A, Estrada JP, et al. Timing of adjuvant radiotherapy in glioblastoma patients: a single-institution experience with more than 400 patients. Neurosurgery. 2016;78(5):676-682.
  15. Spratt DE, Folkert M, Zumsteg ZS, et al. Temporal relationship of post- operative radiotherapy with temozolomide and oncologic outcome for glioblastoma. J Neurooncol. 2014;116(2):357-363.
  16. Blumenthal DT, Won M, Mehta MP, et al. Short delay in initiation of radiotherapy may not affect outcome of patients with glioblastoma: a secondary analysis from the radiation therapy oncology group database. J Clin Oncol. 2009;27(5):733-739.
  17. Grambsch PM, Therneau TM. Proportional hazards tests and diagnostics based on weighted residuals. Biometrika. 1994;81(3):515-526.
  18. Paul HCE, Marx BD. Flexible smoothing with B-splines and penalties. Stat Sci. 1996;11(2):89-102.
  19. R: A Language and Environment for Statistical Computing [computer program]. Version 3.1.2. Vienna, Austria: R Foundation for Statistical Computing; 2016.
  20. Rao RD, Thomé SD, O'Fallon J, Earle JD,Dinapoli RP, Buckner JC. Safety of thrice-daily hyperfractionated radiation and BCNU for high-grade glio- mas. Int J Radiat Oncol Biol Phys. 2002;53(2):376-384.
  21. Groves MD, Maor MH, Meyers C, et al. A phase II trial of high-dose bro- modeoxyuridine with accelerated fractionation radiotherapy followed by procarbazine, lomustine, and vincristine for glioblastoma multiforme. Int J Radiat Oncol Biol Phys. 1999;45(1):127-135.
  22. Aristizibal SA, Caldwell WL. Time-dose-volume relationships in the treatment of glioblastoma multiforme. Radiology. 1971;101(1):201-202.
  23. Withers HR, Taylor JM, Maciejewski B. The hazard of acceler- ated tumor clonogen repopulation during radiotherapy. Acta Oncol. 1988;27(2):131-146.
  24. Budach W, Gioioso D, Taghian A, Stuschke M, Suit HD. Repopulation capacity during fractionated irradiation of squamous cell carcinomas and glioblastomas in vitro. Int J Radiat Oncol Biol Phys. 1997;39(3):743-750.
  25. Pedicini P, Fiorentino A, Simeon V, et al. Clinical radiobiology of glio- blastoma multiforme: estimation of tumor control probability from various radiotherapy fractionation schemes. Strahlenther Onkol. 2014;190(10):925-932.