Early progression of glioblastoma before radiotherapy.

[OBJECTIVE] To analyze the influence of continued growth of glioblastoma between surgery and radiotherapy on subsequent survival.

[MATERIAL AND METHODS] Fractionation with a prescribed dose of 2 and 3 Gy was alternately applied using a pairwise modeling strategy in 140 patients with morphologically confirmed glioblastoma (grade 4). Early progression of disease between microsurgery and radiotherapy was diagnosed in 60 patients, and no tumor growth was noted in 80 patients.

[RESULTS] The minimum period of early progression was 0.33 months, maximum - 4.27 months (median 1.1 (95.0% CI: 0.9-1.3)). The most significant predictors of early progression were resection quality (<0.0001), large residual tumor (=0.003) and no MGMT promoter methylation (=0.001). IDH1 status did not affect early progression. In residual tumor ≥1.2 cm, the median period of early progression was 1.9 months (=70; 95% Cl: 1.3-2.5), <1.2 cm - 3.5 months (=70; =0.019). After resection of less than 76% of tumor, this value was 1.1 months (=28), ≥76% - 3.1 months (=112; =0.006). Without tumor growth, the median overall survival was 33.41 months (=80; 95% Cl: 27.1-39.7), with early progression - 16.03 months (=60; 95% Cl: 13.5-18.6; <0.0001). This predictor was significant for fractionation with a prescribed dose of 3 Gy (<0.0001) and standard radiotherapy (2 Gy; =0.028). By December 2022, 26 out of 40 patients without early progression survived two years after treatment (3 Gy) (65%, median not reached). In case of fractionation with a prescribed dose of 2 Gy, 20 patients survived this period (50%, median reached).

[CONCLUSION] Almost half of patients with newly diagnosed glioblastoma develop early progression between microsurgery and radiotherapy. Therefore, patients with and without early progression should be probably assigned to different prognostic groups regarding overall survival.