Semiz Volkan, Cetinayak Hasan Oguz, Aydin Barbaros, Umay Cenk, Can Fadime
1Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
2Department of Radiation Oncology, Izmir City Hospital, Izmir, Turkey.
Radiol Oncol. 2025 May 14;59(2):244-251. doi: 10.2478/raon-2025-0031. eCollection 2025 Jun 1.
Surgery followed by chemoradiotherapy (CRT) with temozolomide is the standard treatment for glioblastoma patients. But, the time between surgery and CRT is still a controversial issue. This study investigated the impact of delay in CRT after surgery on overall (OS) and progression-free survival (PFS).
Patients aged ≥ 18 years with IDH-wild type glioblastoma, who received 60 Gy concomitant CRT with temozolomide were included in the study. Exclusion criteria include patients who underwent biopsy only, had an Eastern Cooperative Oncology Group (ECOG) performance status > 1, or presented with multicentric tumors. The interval between surgery and CRT was categorized according to 42 days, and delays after this point were defined as delayed treatment initiation. Statistical analyses included Kaplan-Meier survival analysis and Cox regression models.
The median OS for the regular and delayed groups was 18 and 19 months, and the PFS was 11.8 and 14.6 months, respectively. Delayed patients showed better PFS, but no statistically significant difference was found between the groups in terms of OS and PFS (p = 0.149, p = 0.076). In multivariate analysis, ECOG performance score 1 and subtotal resection were associated with poor prognosis for both OS and PFS (for OS p = 0.031, p < 0.001; for PFS p = 0.038, p = 0.029). When the time from surgery to CRT was analyzed according to the extent of surgery, no significant difference was observed in OS and PFS (p = 0.068, P = 0.057).
Our findings showed that delays of more than 42 days in adjuvant CRT did not affect OS or PFS. However, further studies are needed to evaluate the effects of delayed adjuvant therapy in patients with subtotal resection.
手术联合替莫唑胺同步放化疗（CRT）是胶质母细胞瘤患者的标准治疗方法。但是，手术与CRT之间的时间间隔仍是一个有争议的问题。本研究调查了手术后延迟进行CRT对总生存期（OS）和无进展生存期（PFS）的影响。
年龄≥18岁、异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤且接受60 Gy替莫唑胺同步CRT的患者纳入本研究。排除标准包括仅接受活检的患者、东部肿瘤协作组（ECOG）体能状态>1的患者或多中心肿瘤患者。手术与CRT之间的间隔根据42天进行分类，在此时间点之后的延迟定义为延迟开始治疗。统计分析包括Kaplan-Meier生存分析和Cox回归模型。
常规组和延迟组的中位OS分别为18个月和19个月，PFS分别为11.8个月和14.6个月。延迟治疗的患者显示出更好的PFS，但两组在OS和PFS方面未发现统计学上的显著差异（p = 0.149，p = 0.076）。在多变量分析中，ECOG体能状态评分为1和次全切除与OS和PFS的不良预后相关（对于OS，p = 0.031，p < 0.001；对于PFS，p = 0.038，p = 0.029）。根据手术范围分析从手术到CRT的时间时，OS和PFS未观察到显著差异（p = 0.068，P = 0.057）。
我们的研究结果表明，辅助性CRT延迟超过42天不影响OS或PFS。然而，需要进一步研究来评估延迟辅助治疗对次全切除患者的影响。
