Wang Tony J C, Jani Ashish, Estrada Juan P, Ung Timothy H, Chow Daniel S, Soun Jennifer E, Saad Shumaila, Qureshi Yasir H, Gartrell Robyn, Isaacson Steven R, Cheng Simon K, McKhann Guy M, Bruce Jeffrey N, Lassman Andrew B, Sisti Michael B
*Department of Radiation Oncology, Columbia University Medical Center, New York, New York;‡Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York;§Department of Neurological Surgery, Columbia University Medical Center, New York, New York;¶Department of Radiology, Columbia University Medical Center, New York, New York;‖The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York;#Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York;**Department of Neurology, Columbia University Medical Center, New York, New York.
Neurosurgery. 2016 May;78(5):676-82. doi: 10.1227/NEU.0000000000001036.
The standard of care for patients with newly diagnosed glioblastoma (GBM) is maximal safe resection followed by adjuvant radiation therapy (RT) and temozolomide (TMZ).
To investigate whether the timing of adjuvant RT after surgery affected outcome in patients with GBM.
We retrospectively reviewed all patients with a diagnosis of GBM at our institution. A total of 447 patients were included in our analysis. Patients were divided into 3 equal groups based on the interval between surgery and RT. The primary outcome was overall survival (OS).
Patients who began RT less than 21 days after surgery tended to be older, have a lower a Karnofsky Performance Status score, and higher recursive partitioning analysis class. These patients were more likely to have undergone biopsy only and received 3-dimensional conformal RT or 2-dimensional RT. The median OS for patients who started RT less than 21 days after surgery, between 21 and 32 days after surgery, and more than 32 days after surgery was 374, 465, and 478 days, respectively (P = .004). On multivariate Cox regression analysis, Karnofsky Performance Status score lower than 70, undergoing biopsy only, recursive partitioning analysis classes IV and V/VI, use of less than 36 Gy RT, and lack of TMZ chemotherapy were predictors of worse OS. The interval between surgery and RT was not significantly associated with OS on multivariate analysis.
Patients who begin RT less than 21 days after surgery tend to have worse prognostic factors than those who begin RT later. When accounting for significant covariates, the effect of timing between surgery and RT is not significant.
新诊断的胶质母细胞瘤（GBM）患者的标准治疗方案是最大程度安全切除，随后进行辅助放疗（RT）和替莫唑胺（TMZ）治疗。
研究手术后辅助放疗的时机是否会影响GBM患者的预后。
我们回顾性分析了本机构所有诊断为GBM的患者。共有447例患者纳入分析。根据手术与放疗之间的间隔时间，将患者分为3组，每组人数相等。主要结局指标为总生存期（OS）。
术后不到21天开始放疗的患者往往年龄较大，卡氏功能状态评分较低，递归分区分析分级较高。这些患者更有可能仅接受了活检，并接受了三维适形放疗或二维放疗。术后不到21天、术后21至32天以及术后超过32天开始放疗的患者，其OS中位数分别为374天、465天和478天（P = 0.004）。多因素Cox回归分析显示，卡氏功能状态评分低于70、仅接受活检、递归分区分析分级为IV级和V/VI级、放疗剂量低于36 Gy以及未接受TMZ化疗是OS较差的预测因素。多因素分析显示，手术与放疗之间的间隔时间与OS无显著相关性。
术后不到21天开始放疗的患者，其预后因素往往比晚些开始放疗的患者更差。在考虑显著的协变量后，手术与放疗之间的时间间隔对预后的影响不显著。
