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Early initiation of chemoradiation following index craniotomy is associated with decreased survival in high-grade glioma.

Al's Comment:

 Very interesting study. It says that starting radiation therapy earlier than we usual do actually is worse for the patient. The study was performed just by looking at billing records.  I would like to see more research on this. Perhaps look at the reasons radiation was started earlier. Maybe those patients had a lot of residual tumor so they were rushed into radiation as there was less space for recurrence? Or had some other medical reasons.


Posted on: 07/29/2017

. J Neurooncol. 2017 Jul 25. doi: 10.1007/s11060-017-2577-7. [Epub ahead of print]

Early initiation of chemoradiation following index craniotomy is associated with decreased survival in high-grade glioma.

Nathan JK1, Brezzell AL2, Kim MM3, Leung D4, Wilkinson DA2, Hervey-Jumper SL2,5.
 
Author information:
 
1
    Department of Neurosurgery, University of Michigan Hospital, 1500 E. Medical Center Drive, SPC 5338, Ann Arbor, MI, 48109-5338, USA. janathan@med.umich.edu.
2
    Department of Neurosurgery, University of Michigan Hospital, 1500 E. Medical Center Drive, SPC 5338, Ann Arbor, MI, 48109-5338, USA.
3
    Department of Radiation Oncology, University of Michigan Hospital, Ann Arbor, MI, USA.
4
    Department of Neurology, University of Michigan Hospital, Ann Arbor, MI, USA.
5
    Department of Neurosurgery and Brain Tumor Research Center, University of California San Francisco, San Francisco, CA, USA.
 
Abstract
 
The Stupp protocol of post-resection external beam radiation therapy and concomitant temozolomide is the standard of care for patients with newly-diagnosed glioblastoma, with expanded use in anaplastic astrocytoma. However, the optimal interval between surgery and these adjuvant therapies, and its impact on survival, is unknown. To investigate this, de-identified claims from a large, private health insurance database were queried to identify adult patients who underwent index craniotomy for resection of a supratentorial neoplasm during the period 2005-2014 and began postoperative radiation and temozolomide within 13 weeks of surgery. A total of 2535 patients were assigned to groups based on interval from surgery to first radiation treatment of up to 4 weeks, 4-6 weeks, or 6-13 weeks. Of these, 1098 patients began radiation treatment within 4 weeks of craniotomy, 1019 between 4 and 6 weeks, and 418 between 6 and 13 weeks. There was significant regional variation in treatment schedule in the United States. Survival was calculated based on time from first craniotomy to death. Kaplan-Meier plot and multivariate Cox proportional hazard regression demonstrated a statistically significant association between earliest postoperative radiation and decreased survival (hazard ratio 1.31), along with older age and male sex. Earlier initiation of postoperative radiation for high-grade glioma is not associated with increased survival. Rather, beginning radiation treatment within 4 weeks of craniotomy was associated with significantly worse survival compared to initiation of treatment 4-13 weeks after craniotomy. This is the largest population-based study to date regarding timing of Stupp protocol initiation.
PMID: 28744829
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