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Optimal timing of chemoradiotherapy after surgical resection of glioblastoma: Stratification by validated prognostic classification
Author(s) -
Press Robert H.,
Shafer Sarah L.,
Jiang Renjian,
Buchwald Zachary S.,
Abugideiri Mustafa,
Tian Sibo,
Morgan Tiffany M.,
Behera Madhusmita,
Sengupta Soma,
Voloschin Alfredo D.,
Olson Jeffrey J.,
Hasan Shaakir,
Blumenthal Deborah T.,
Curran Walter J.,
Eaton Bree R.,
Shu HuiKuo G.,
Zhong Jim
Publication year - 2020
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32797
Subject(s) - medicine , hazard ratio , proportional hazards model , glioblastoma , recursive partitioning , cohort , chemoradiotherapy , oncology , multivariate analysis , subgroup analysis , survival analysis , cancer , radiation therapy , surgery , confidence interval , cancer research
Background Previous studies examining the time to initiate chemoradiation (CRT) after surgical resection of glioblastoma have been conflicting. To better define the effect that the timing of adjuvant treatment may have on outcomes, the authors examined patients within the National Cancer Database (NCDB) stratified by a validated prognostic classification system. Methods Patients with glioblastoma in the NCDB who underwent surgery and CRT from 2004 through 2013 were analyzed. Radiation Therapy Oncology Group recursive partitioning analysis (RPA) class (III, IV, V) was extrapolated for the cohort. Time intervals were grouped weekly, with weeks 4 to 5 serving as the reference category for analyses. Kaplan‐Meier analysis, log‐rank testing, and multivariate (MVA) Cox proportional hazards regression were performed. Results In total, 30,414 patients were included. RPA classes III, IV, and V contained 5250, 20,855, and 4309 patients, respectively. On MVA, no time point after week 5 was associated with a change in overall survival for the entire cohort or for any RPA class subgroup. The periods of weeks 0 to 1 (hazard ratio [HR], 1.18; 95% CI, 1.02‐1.36), >1 to 2 (HR, 1.23; 95% CI, 1.16‐1.31), and >2 to 3 (HR, 1.11; 95% CI, 1.07‐1.15) demonstrated slightly worse overall survival (all P < .03). The detriment to early initiation was consistent across each RPA class subgroup. Conclusions The current data provide insight into the optimal timing of CRT in patients with glioblastoma and describe RPA class‐specific outcomes. In general, short delays beyond 5 weeks did not negatively affect outcomes, whereas early initiation before 3 weeks may be detrimental.