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Glioblastoma Multiformede Adjuvan Kemoradyoterapi Başlama Zamanının Prognoz Üzerine Etkisi

Year 2025, Volume: 78 Issue: 1, 20 - 26, 31.03.2025

Engin Eren Kavak

Abstract

Project Number

-

References

  • 1. Miller KD, Ostrom QT, Kruchko C, et al. Brain and other central nervous system tumor statistics, 2021. CA Cancer J Clin. 2021;71:381-406.
  • 2. Louis DN, Perry A, Wesseling P, et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro Oncol. 2021;23:1231-1251.
  • 3. Molinaro AM, Taylor JW, Wiencke JK, et al. Genetic and molecular epidemiology of adult diffuse glioma. Nat Rev Neurol. 2019;15:405-417.
  • 4. Skaga E, Skretteberg MA, Johannesen TB, et al. Real-world validity of randomized controlled phase III trials in newly diagnosed glioblastoma: to whom do the results of the trials apply? Neurooncol Adv. 2021;3:vdab008.
  • 5. Sulman EP, Ismaila N, Armstrong TS, et al. Radiation therapy for glioblastoma: American Society of Clinical Oncology clinical practice guideline endorsement of the American Society for Radiation Oncology Guideline. J Clin Oncol. 2017;35:361-369.
  • 6. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987-996.
  • 7. Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTCNCIC trial. Lancet Oncol. 2009;10:459-466.
  • 8. Weller M, van den Bent M, Hopkins K, et al. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol. 2014;15:e395-403.
  • 9. Ürün M, Sezgin Y, Uysal E. The impact of timing adjuvant therapy on disease-free survival among patients with stage iib-iiia non-small cell lung cancer receiving platinumbased treatment. Turk J Clin Lab. 2023;14:639-644.
  • 10. Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, et al. Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol. 2016;2:322-329.
  • 11. Ius T, Somma T, Pasqualetti F, et al. Local therapy in glioma: an evolving paradigm from history to horizons (Review). Oncol Lett. 2024;28:440.
  • 12. Abacıoğlu U, Çetin İ, Akgün Z et al. Treatment results and prognostic factors for adult patients with diagnosis of glioblastoma multiforme after radiotherapy. Turk J Oncol. 2004;19:112-118.
  • 13. Gilbert MR, Wang M, Aldape KD, et al. Dose-dense temozolomide for newly diagnosed glioblastoma: a randomized phase III clinical trial. J Clin Oncol. 2013;31:4085-4091.
  • 14. Benli Yavuz B, Kanyılmaz G, Aktan M. Comparison of prognostic factors in glioblastoma patients with short- and long-term survival. Turk J Oncol. 2023;38:392-398.
  • 15. Benzekry S, Lamont C, Beheshti A, et al. Classical mathematical models for description and prediction of experimental tumor growth. PLoS Comput Biol. 2014;10:e1003800.
  • 16. Burnet NG, Jena R, Jefferies SJ, et al. Mathematical modelling of survival of glioblastoma patients suggests a role for radiotherapy dose escalation and predicts poorer outcome after delay to start treatment. Clin Oncol (R Coll Radiol). 2006;18:93-103.
  • 17. 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;27:733-739.
  • 18. Pollom EL, Fujimoto DK, Han SS, et al. Newly diagnosed glioblastoma: adverse socioeconomic factors correlate with delay in radiotherapy initiation and worse overall survival. J Radiat Res. 2018;59(suppl_1):i11-i18.
  • 19. Nathan JK, Brezzell AL, Kim MM, et al. Early initiation of chemoradiation following index craniotomy is associated with decreased survival in highgrade glioma. J Neurooncol. 2017;135:325-333.
  • 20. Zur I, Tzuk-Shina T, Guriel M, et al. Survival impact of the time gap between surgery and chemo-radiotherapy in glioblastoma patients. Sci Rep. 2020;10:9595.
  • 21. Han SJ, Rutledge WC, Molinaro AM, et al. The effect of timing of concurrent chemoradiation in patients with newly diagnosed glioblastoma. Neurosurgery. 2015;77:248-253.
  • 22. 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;78:676-682.
  • 23. Adeberg S, Bostel T, Harrabi S, et al. Impact of delays in initiating postoperative chemoradiation while determining the MGMT promotermethylation statuses of patients with primary glioblastoma. BMC Cancer.2015;15:558.
  • 24. Spratt DE, Folkert M, Zumsteg ZS, et al. Temporal relationship of postoperative radiotherapy with temozolomide and oncologic outcome for glioblastoma. J Neurooncol. 2014;116:357-363.
  • 25. Loureiro LV, Victor Eda S, Callegaro-Filho D, et al. Minimizing the uncertainties regarding the effects of delaying radiotherapy for Glioblastoma: a systematic review and meta-analysis. Radiother Oncol. 2016;118:1-8.

The Effect of Adjuvant Chemoradiotherapy Initiation Time on Prognosis in Glioblastoma Multiforme

Year 2025, Volume: 78 Issue: 1, 20 - 26, 31.03.2025

Engin Eren Kavak

Abstract

Objectives: To determine survival and investigate associated prognostic factors in glioblastoma multiforme (GBM) patients receiving adjuvant therapy.

Materials and Methods: The study population comprised patients with isocitrate dehydrogenase wild-type GBM who were enrolled between 1 September 2022 and 1 March 2024. The primary endpoint was overall survival (OS), while the secondary endpoint was progression-free survival. Comparisons between groups were conducted using the log-rank test, and multivariate analyses were performed using Cox regression.

Results: A total of 67 patients were evaluated. The median OS of patients was 19.3 months [95% confidence interval (CI) 15.1 to not reached (NR)].A total of 60 patients (89.1%) underwent adjuvant treatment. The median OS was 31.1 months (95% CI 19.3 to NR) for patients treated within the first four weeks, 15.7 months (95% CI 15.1 to NR) for those treated within four to six weeks, and 11.3 months (95% CI 9.8 to NR) for those treated after six weeks.

Conclusion: The observed survival rate in our study was comparable to that reported in clinical trials. However, the survival rate was significantly lower in patients who received treatment at a later stage. Therefore, further studies with larger patient populations are recommended to ensure that the guidelines more accurately reflect the timing of adjuvant therapy in GBM patients.

Keywords

Glioblastoma multiforme stupp protocol overall survival time to treatment

Ethical Statement

This study was approved by the Scientific Research Evaluation and Ethics Committee of Etlik City Hospital (decision no.: AEŞH-BADEK-2024-758, date: 02.10.2024).

Supporting Institution

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Project Number

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Thanks

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References

  • 1. Miller KD, Ostrom QT, Kruchko C, et al. Brain and other central nervous system tumor statistics, 2021. CA Cancer J Clin. 2021;71:381-406.
  • 2. Louis DN, Perry A, Wesseling P, et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro Oncol. 2021;23:1231-1251.
  • 3. Molinaro AM, Taylor JW, Wiencke JK, et al. Genetic and molecular epidemiology of adult diffuse glioma. Nat Rev Neurol. 2019;15:405-417.
  • 4. Skaga E, Skretteberg MA, Johannesen TB, et al. Real-world validity of randomized controlled phase III trials in newly diagnosed glioblastoma: to whom do the results of the trials apply? Neurooncol Adv. 2021;3:vdab008.
  • 5. Sulman EP, Ismaila N, Armstrong TS, et al. Radiation therapy for glioblastoma: American Society of Clinical Oncology clinical practice guideline endorsement of the American Society for Radiation Oncology Guideline. J Clin Oncol. 2017;35:361-369.
  • 6. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987-996.
  • 7. Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTCNCIC trial. Lancet Oncol. 2009;10:459-466.
  • 8. Weller M, van den Bent M, Hopkins K, et al. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol. 2014;15:e395-403.
  • 9. Ürün M, Sezgin Y, Uysal E. The impact of timing adjuvant therapy on disease-free survival among patients with stage iib-iiia non-small cell lung cancer receiving platinumbased treatment. Turk J Clin Lab. 2023;14:639-644.
  • 10. Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, et al. Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol. 2016;2:322-329.
  • 11. Ius T, Somma T, Pasqualetti F, et al. Local therapy in glioma: an evolving paradigm from history to horizons (Review). Oncol Lett. 2024;28:440.
  • 12. Abacıoğlu U, Çetin İ, Akgün Z et al. Treatment results and prognostic factors for adult patients with diagnosis of glioblastoma multiforme after radiotherapy. Turk J Oncol. 2004;19:112-118.
  • 13. Gilbert MR, Wang M, Aldape KD, et al. Dose-dense temozolomide for newly diagnosed glioblastoma: a randomized phase III clinical trial. J Clin Oncol. 2013;31:4085-4091.
  • 14. Benli Yavuz B, Kanyılmaz G, Aktan M. Comparison of prognostic factors in glioblastoma patients with short- and long-term survival. Turk J Oncol. 2023;38:392-398.
  • 15. Benzekry S, Lamont C, Beheshti A, et al. Classical mathematical models for description and prediction of experimental tumor growth. PLoS Comput Biol. 2014;10:e1003800.
  • 16. Burnet NG, Jena R, Jefferies SJ, et al. Mathematical modelling of survival of glioblastoma patients suggests a role for radiotherapy dose escalation and predicts poorer outcome after delay to start treatment. Clin Oncol (R Coll Radiol). 2006;18:93-103.
  • 17. 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;27:733-739.
  • 18. Pollom EL, Fujimoto DK, Han SS, et al. Newly diagnosed glioblastoma: adverse socioeconomic factors correlate with delay in radiotherapy initiation and worse overall survival. J Radiat Res. 2018;59(suppl_1):i11-i18.
  • 19. Nathan JK, Brezzell AL, Kim MM, et al. Early initiation of chemoradiation following index craniotomy is associated with decreased survival in highgrade glioma. J Neurooncol. 2017;135:325-333.
  • 20. Zur I, Tzuk-Shina T, Guriel M, et al. Survival impact of the time gap between surgery and chemo-radiotherapy in glioblastoma patients. Sci Rep. 2020;10:9595.
  • 21. Han SJ, Rutledge WC, Molinaro AM, et al. The effect of timing of concurrent chemoradiation in patients with newly diagnosed glioblastoma. Neurosurgery. 2015;77:248-253.
  • 22. 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;78:676-682.
  • 23. Adeberg S, Bostel T, Harrabi S, et al. Impact of delays in initiating postoperative chemoradiation while determining the MGMT promotermethylation statuses of patients with primary glioblastoma. BMC Cancer.2015;15:558.
  • 24. Spratt DE, Folkert M, Zumsteg ZS, et al. Temporal relationship of postoperative radiotherapy with temozolomide and oncologic outcome for glioblastoma. J Neurooncol. 2014;116:357-363.
  • 25. Loureiro LV, Victor Eda S, Callegaro-Filho D, et al. Minimizing the uncertainties regarding the effects of delaying radiotherapy for Glioblastoma: a systematic review and meta-analysis. Radiother Oncol. 2016;118:1-8.
There are 25 citations in total.

Details

Primary Language English
Subjects Clinical Oncology
Journal Section Articles
Authors

Engin Eren Kavak 0000-0003-3247-5361

Project Number -
Publication Date March 31, 2025
Submission Date October 16, 2024
Acceptance Date January 12, 2025
Published in Issue Year 2025 Volume: 78 Issue: 1

Cite

APA Kavak, E. E. (2025). The Effect of Adjuvant Chemoradiotherapy Initiation Time on Prognosis in Glioblastoma Multiforme. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 78(1), 20-26. https://doi.org/10.4274/atfm.galenos.2025.01069
AMA Kavak EE. The Effect of Adjuvant Chemoradiotherapy Initiation Time on Prognosis in Glioblastoma Multiforme. Ankara Üniversitesi Tıp Fakültesi Mecmuası. March 2025;78(1):20-26. doi:10.4274/atfm.galenos.2025.01069
Chicago Kavak, Engin Eren. “The Effect of Adjuvant Chemoradiotherapy Initiation Time on Prognosis in Glioblastoma Multiforme”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 78, no. 1 (March 2025): 20-26. https://doi.org/10.4274/atfm.galenos.2025.01069.
EndNote Kavak EE (March 1, 2025) The Effect of Adjuvant Chemoradiotherapy Initiation Time on Prognosis in Glioblastoma Multiforme. Ankara Üniversitesi Tıp Fakültesi Mecmuası 78 1 20–26.
IEEE E. E. Kavak, “The Effect of Adjuvant Chemoradiotherapy Initiation Time on Prognosis in Glioblastoma Multiforme”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 78, no. 1, pp. 20–26, 2025, doi: 10.4274/atfm.galenos.2025.01069.
ISNAD Kavak, Engin Eren. “The Effect of Adjuvant Chemoradiotherapy Initiation Time on Prognosis in Glioblastoma Multiforme”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 78/1 (March 2025), 20-26. https://doi.org/10.4274/atfm.galenos.2025.01069.
JAMA Kavak EE. The Effect of Adjuvant Chemoradiotherapy Initiation Time on Prognosis in Glioblastoma Multiforme. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2025;78:20–26.
MLA Kavak, Engin Eren. “The Effect of Adjuvant Chemoradiotherapy Initiation Time on Prognosis in Glioblastoma Multiforme”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 78, no. 1, 2025, pp. 20-26, doi:10.4274/atfm.galenos.2025.01069.
Vancouver Kavak EE. The Effect of Adjuvant Chemoradiotherapy Initiation Time on Prognosis in Glioblastoma Multiforme. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2025;78(1):20-6.
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