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Delaying standard combined chemoradiotherapy after surgical resection does not impact survival in newly diagnosed glioblastoma patients

Guillaume Louvel 1, 2, 3 Philippe Metellus 4 Georges Noel 5 Sophie Peeters 6, 7 Jacques Guyotat 8 Julien Duntze 9 Pierre-Jean Le Reste 10 Phong Dam Hieu 11 Thierry Faillot 12 Fabien Litre 9 Nicolas Desse 13 Antoine Petit 14 Evelyne Emery 15 Jimmy Voirin 16 Johann Peltier 17 François Caire 18 Jean-Rodolphe Vignes 19 Jean-Luc Barat 20 Olivier Langlois 21 Philippe Menei 22 Sarah Dumont 23, 24 Marc Zanello 7 Edouard Dezamis 25 Frédéric Dhermain 2, 3 Johan Pallud 7
Abstract : BACKGROUND:To assess the influence of the time interval between surgical resection and standard combined chemoradiotherapy on survival in newly diagnosed and homogeneously treated (surgical resection plus standard combined chemoradiotherapy) glioblastoma patients; while controlling confounding factors (extent of resection, carmustine wafer implantation, functional status, neurological deficit, and postoperative complications).METHODS:From 2005 to 2011, 692 adult patients (434 men; mean of 57.5 ± 10.8 years) with a newly diagnosed glioblastoma were enrolled in this retrospective multicentric study. All patients were treated by surgical resection (65.5% total/subtotal resection, 34.5% partial resection; 36.7% carmustine wafer implantation) followed by standard combined chemoradiotherapy (radiotherapy at a median dose of 60 Gy, with daily concomitant and adjuvant temozolomide). Time interval to standard combined chemoradiotherapy was analyzed as a continuous variable and as a dichotomized variable using median and quartiles thresholds. Multivariate analyses using Cox modeling were conducted.RESULTS:The median progression-free survival was 10.3 months (95% CI, 10.0-11.0). The median overall survival was 19.7 months (95% CI, 18.5-21.0). The median time to initiation of combined chemoradiotherapy was 1.5 months (25% quartile, 1.0; 75% quartile, 2.2; range, 0.1-9.0). On univariate and multivariate analyses, OS and PFS were not significantly influenced by time intervals to adjuvant treatments. On multivariate analysis, female gender, total/subtotal resection and RTOG-RPA classes 3 and 4 were significant independent predictors of improved OS.CONCLUSIONS:Delaying standard combined chemoradiotherapy following surgical resection of newly diagnosed glioblastoma in adult patients does not impact survival.
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Submitted on : Wednesday, February 20, 2019 - 3:01:39 PM
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Guillaume Louvel, Philippe Metellus, Georges Noel, Sophie Peeters, Jacques Guyotat, et al.. Delaying standard combined chemoradiotherapy after surgical resection does not impact survival in newly diagnosed glioblastoma patients. Radiotherapy and Oncology, Elsevier, 2016, 118 (1), pp.9-15. ⟨10.1016/j.radonc.2016.01.001⟩. ⟨hal-02042644⟩



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