The effect of waiting for radiotherapy for grade III/IV gliomas

Aim: To determine the effect of waiting time for radiotherapy on the overal l survival of patients with high-grade gliomas. Methods: We examined records of patients with grade III/IV gliomas who were referred to radiotherapy after surgery or biopsy - ECOG <3, any age, radic al intent or palliative intent with dose >50 Gy, no interstitial or radiosu rgery boost. Waiting time was defined in two ways, time from biopsy to radi otherapy and time from presentation to radiotherapy department to start of radiotherapy. Results: There were 182 patients in the study having a median survival of 8 .5 months, with a median follow up of 10.5 months. The group comprised of 6 3 (35%) grade III and 119 (65%) grade IV gliomas. Median times and ranges f rom biopsy and presentation to treatment were 26 days (4-78 days) and 15 da ys (1-62 days), respectively. The median dose was 60 Gy in a median of 30 f ractions over a median of 46 days. Tumour progression before and during rad iotherapy occurred in seven patients (4%) and 19 patients (11%), respective ly. One hundred and seventy-nine patients died of disease. The seven patien ts whose tumour progressed before radiotherapy were excluded from the analy sis of prognostic variables. In a multivariate analysis the variables that were significantly associated with worse survival were older age, reduced d ose and prolonged waiting time from presentation. The risk of death increas ed by 2% for each day of waiting for radiotherapy. Conclusion: The study showed longer waiting time from presentation at radio therapy department to treatment to be a significant predictor of overall su rvival for patients with high-grade glioma. (C) 2000 Elsevier Science Irela nd Ltd. All rights reserved.