Abstract
Fractionated external beam radiotherapy is an important component of standard treatment for high grade glioma. Due to resource constraints, patients may experience delays in receiving treatment. The purpose of this study was to evaluate the effect of radiotherapy waiting time on survival in patients with high grade glioma. A retrospective analysis was performed of 172 patients with a histological diagnosis of WHO Grade 3 or 4 Astrocytoma who had undergone surgery at Wellington Hospital between 1993 and 2003, and who subsequently underwent radiotherapy. Time to radiotherapy after surgery varied from 7 days to over 16 weeks. Multiple Cox regression analysis showed that age, performance status, tumour grade, extent of surgical resection, radiotherapy dose, and time to radiotherapy from day of surgery were all independently related to survival. Every additional week of delay until the start of radiotherapy increases the risk of death (hazard ratio) by 8.9% (95%CI 2.0%–16.1%). A 6 week delay in starting radiotherapy (from 2 weeks post-op to 8 weeks) reduces median survival by 11 weeks for a typical patient. Delay in radiotherapy results in a clinically significant reduction in survival. These findings have implications for resource allocation and for the design of clinical trials.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996
Anonymous (1990) Prognostic factors for high-grade malignant glioma: development of a prognostic index. A report of the medical research council brain tumour working party. J Neurooncol 9:47–55
Lin D, Wei L, Ying Z (1993) Checking the cox model with cumulative sums of martingale-based residuals. Biometrika 80:557–572
Richards MA, Westcombe AM, Love SB et al (1999) Influence of delay on survival in patients with breast cancer: a systematic review. Lancet 353:1119–1126
Fazeny-Dorner B, Wenzel C, Veitl M et al (2003) Survival and prognostic factors of patients with unresectable glioblastoma multiforme. Anti-Cancer Drugs 14:305–312
Fazeny-Dorner B, Gyries A, Rossler K et al (2003) Survival improvement in patients with glioblastoma multiforme during the last 20 years in a single tertiary-care center. Wien Klin Wochenschr 115:389–397
Kleinberg L, Grossman S, Piantadosi S et al (1999) The effects of sequential versus concurrent chemotherapy and radiotherapy on survival and toxicity in patients with newly diagnosed high-grade astrocytoma. Int J Radiat Oncol Biol Phys 44:535–543
Do V, Gebski V, Barton MB (2000) The effect of waiting for radiotherapy for grade III/IV gliomas. Radiother Oncol 57:131–136
Burnet N, Jena R, Jefferies SJ et al (2006) 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 18:93–103
Walker M, Strike T, Sheline GE et al (1979) An analysis of dose-effect relationship in the radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys 5:1725–1731
Bleehen NM, Stenning SP (1991) Medical research council trial of two radiotherapy doses in the treatment of grades 3 and 4 astrocytoma. The medical research council brain tumour working party. Br J Cancer 64:769–774
Acknowledgements
We would like to acknowledge the Wellington Surgical Research Trust for their assistance in the form a summer studentship for Dr Irwin.
Author information
Authors and Affiliations
Corresponding author
Additional information
This study was approved by the Central Regional Ethics Committee, New Zealand.
Rights and permissions
About this article
Cite this article
Irwin, C., Hunn, M., Purdie, G. et al. Delay in radiotherapy shortens survival in patients with high grade glioma. J Neurooncol 85, 339–343 (2007). https://doi.org/10.1007/s11060-007-9426-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-007-9426-z