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Surgery to chemoradiotherapy time may not impact outcomes in glioblastoma patients treated with modern techniques: a single-institution study

Volkan Semiz

Volkan Semiz

  • Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylul UniversityIzmir, Turkey
  • Department of Radiation Oncology, Izmir City HospitalIzmir, Turkey
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Semiz, Volkan
, 
Hasan Oguz Cetinayak

Hasan Oguz Cetinayak

Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylul UniversityIzmir, Turkey
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Cetinayak, Hasan Oguz
, 
Barbaros Aydin

Barbaros Aydin

Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylul UniversityIzmir, Turkey
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Aydin, Barbaros
, 
Cenk Umay

Cenk Umay

Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylul UniversityIzmir, Turkey
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Umay, Cenk
 und 
Fadime Can

Fadime Can

Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylul UniversityIzmir, Turkey
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Can, Fadime
  
14. Mai 2025
Surgery to chemoradiotherapy time may not impact outcomes in glioblastoma patients treated with modern techniques: a single-institution study's Cover Image
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Artikel-Kategorie: research article
Online veröffentlicht: 14. Mai 2025
Seitenbereich: 244 - 251
Eingereicht: 17. Jan. 2025
Akzeptiert: 03. Apr. 2025
DOI: https://doi.org/10.2478/raon-2025-0031
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© 2025 Volkan Semiz et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

Overall (A) and Progression Free Survival (B)
Overall (A) and Progression Free Survival (B)

Univariate and multivariate Cox regression analysis for progression free survival

Univariate Analyse Multivariate Analyse
HR (95% CI) p value HR (95% CI) p value
Age
 ≤ 55 REF 0.700 (0.445–1.101) 0.122 REF 0.701 (0.437–1.125) 0.141
 > 55
Gender
 Male REF 0.915 (0.638–1.611) 0.915 REF 0.952 (0.591–1.534) 0.839
 Female
ECOG Score
 0 REF 1. 805 (1.026–2.846) 0.023 REF 1.765 (1.032–3.019) 0.038
 1
Extent of Surgery
 GTR REF 2.017 (1.219–3.337) 0.007 REF 1.793 (1.063–3.025) 0.029
 STR
Surgery to CRT
 < 42 days REF 0.652 (0.406–1.046) 0.076 REF 0.643 (0.398–1.039) 0.071
 ≥ 42 days

Literature review of clinical impact of radiation delay following surgical resection

Study Year Patients Cutoff points TMZ Median survival Results
Irwin et al.10 2007 172 2 wks - 7.8 mos in GB 14.9 mos for astrocytoma Increased risk of death by 8.9% for each additional week
Noel et al.18 2012 400 6 wks 67% 13.4 mos No differences in OS
Loureiro et al.19 2015 115 6 wks 60% 13.5 vs. 14.2 mos No differences in OS
Sun et al.16 2015 218 6 wks + 15.2 vs. 12.9 mos Worse OS in > 6 wks
Wang et al.20 2016 447 3 wks 92% 12.3 vs. 15.3 mos Worse OS in < 3 wks
Nathan et al.12 2017 2535 4–6 wks + 21.3 vs. 26.6 vs. 27.6 mos < 4 is associated with a 31% increased risk of death, no difference between > 4 vs. > 6
Blumenthal et al.2 2018 1395 4 wks + 16 vs. 15.9 mos No differences in OS and PFS
Katsigiannis et al.21 2019 151 28–33 days + 15 vs. 17.4 vs. 18.2 mos No difference in OS and PFS among 3 group, but worse OS with > 48 days
Buszek et al.4 2020 45,942 4–8 wks 67% 13.9 vs. 15.2 vs. 14.6 mos 4–8 wks has better OS, In GTR, > 8 wks has worse OS, In STR < 4 wks has worse OS
Ahn et al.22 2020 138 4 wks + 15.5 vs. 14.5 mos No differences in OS and PFS, In STR > 4 week has worse OS
Press et al.17 2020 30,414 0-8 wks N.A. 12.8 to 16.2 mos Worse OS in < 3 weeks No difference beyond 5 wks
Zhang et al.15 2020 66 6 wks + 26.6 vs. 15.7 mos Worse OS and PFS > 6 wks
Current study 2025 91 6 wks + 18 vs. 19 mos No differences in OS and PFS

Univariate and multivariate Cox regression analysis for overall survival

Univariate analyse Multivariate analyse
HR (95% CI) p value HR (95% CI) p value
Age
 ≤ 55 REF 1.284 (0.812–2.031) 0.284 REF 1.535 (0.957–2.462) 0.076
 > 55
Gender
 Male REF 0.874 (0.555–1.375 0.560 REF 0.819 (0.498–1.345 0.430
 Female
ECOG score
 0 REF 1.783 (1.103–2.881 0.018 REF 1.791 (1.056–3.037) 0.031
 1
Extent of Surgery
 GTR REF 2.304 (1.422–3.733) < 0.001 REF 2.921 (1.702–5.014) < 0.001
 STR
Surgery to CRT
 < 42 days REF 0.714 (0.446–1.143) 0.161 REF 0.610 (0.368–1.013) 0.060
 ≥ 42 days

Patient characteristics

All patients (n = 91) < 42 days (n = 56) ≥ 42 days (n = 35)
Surgery to CRT, median (range), days 39 (18–98) days 34 (18–41) days 48 (42–98) days
Age, median (range), years 58 (22–79) 59 (22–77) 58 (27–79) p = 0.798
Gender
 Male 54 (59.3%) 31 (55.4%) 23 (65.7%) p = 0.328
 Female 37 (40.7%) 25 (44.6%) 12 (34.3%)
ECOG Score
 0 63 (69.2%) 36 (64.3%) 27 (77.1%) p = 0.246
 1 28 (31.8%) 20 (35.7%) 8 (12.9%)
Extent of Surgery
 GTR 64 (70.3%) 40 (71.4%) 24 (68.5%) p = 0.816
 STR 27 (29.7%) 16 (28.6%) 11 (31.5%)
Adjuvant temozolomide cycles, median 7 (2–18) cycles 7 (2–18) cycles 7 (3–15) cycles p = 0.385
PTV volumes, mean 186.7 cm3 187.8 cm3 185.2 cm3 p = 0.888
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