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Louvel G, Metellus P, Noel G, Peeters S, Guyotat J, Duntze J, Le Reste PJ, Dam Hieu P, Faillot T, Litre F, Desse N, Petit A, Emery E, Voirin J, Peltier J, Caire F, Vignes JR, Barat JL, Langlois O, Menei P, Dumont SN, Zanello M, Dezamis E, Dhermain F, Pallud J. Delaying standard combined chemoradiotherapy after surgical resection does not impact survival in newly diagnosed glioblastoma patients. Radiother Oncol 2016; 118:9-15. [PMID: 26791930 DOI: 10.1016/j.radonc.2016.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/02/2016] [Accepted: 01/03/2016] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Guillaume Louvel
- Department of Radiation Oncology, INSERM 1030 "Molecular Radiotherapy", Gustave Roussy, Gustave Roussy Cancer Campus, Villejuif, France.
| | - Philippe Metellus
- Department of Neurosurgery, Clairval Private Hospital, Marseille, France; UMR911, CRO2, Aix-Marseille Université, France
| | - Georges Noel
- Department of Radiotherapy, Centre de Lutte Contre le Cancer Paul Strauss, Strasbourg, France; Radiobiology Laboratory, Federation of Translationnal Medicine de Strasbourg (FMTS), Strasbourg University, France
| | - Sophie Peeters
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, France
| | - Jacques Guyotat
- Lyon Civil Hospitals, Pierre Wertheimer Neurological and Neurosurgical Hospital, Service of Neurosurgery D, France
| | - Julien Duntze
- Department of Neurosurgery, Maison Blanche Hospital, Reims University Hospital, France
| | | | - Phong Dam Hieu
- Department of Neurosurgery, University Medical Center, Faculty of Medicine, University of Brest, France
| | - Thierry Faillot
- Department of Neurosurgery, APHP Beaujon Hospital, Clichy, France
| | - Fabien Litre
- Department of Neurosurgery, Maison Blanche Hospital, Reims University Hospital, France
| | - Nicolas Desse
- Department of Neurosurgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Antoine Petit
- Department of Neurosurgery, University Hospital Jean Minjoz, Besançon, France
| | - Evelyne Emery
- Departement of Neurosurgery, University Hospital of Caen, University of Lower Normandy, France
| | - Jimmy Voirin
- Department of Neurosurgery, Pasteur Hospital, Colmar, France
| | - Johann Peltier
- Department of Neurosurgery, Amiens University Hospital, France
| | | | | | - Jean-Luc Barat
- Department of Neurosurgery, Clairval Private Hospital, Marseille, France
| | | | | | - Sarah N Dumont
- Department of Neurooncology, Gustave Roussy, Villejuif, France
| | - Marc Zanello
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, France
| | - Edouard Dezamis
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, France
| | - Frédéric Dhermain
- Department of Radiation Oncology, INSERM 1030 "Molecular Radiotherapy", Gustave Roussy, Gustave Roussy Cancer Campus, Villejuif, France
| | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, France
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