BACKGROUND: The aim of this retrospective study is to assess the incidence, localization, and potential predictors of rapid early progression (REP) prior to initiation of radiotherapy in newly diagnosed glioblastoma patients and to compare survival outcomes in cohorts with or without REP in relation to the treatment. METHODS: We assessed a consecutive cohort of 155 patients with histologically confirmed irradiated glioblastoma from 1/2014 to 12/2017. A total of 90 patients with preoperative, postoperative, and planning MRI were analyzed. RESULTS: Median age 59 years, 59% men, and 39 patients (43%) underwent gross total tumor resection. The Stupp regimen was indicated to 64 patients (71%); 26 patients (29%) underwent radiotherapy alone. REP on planning MRI performed shortly prior to radiotherapy was found in 46 (51%) patients, most often within the surgical cavity wall, and the main predictor for REP was non-radical surgery (p < 0.001). The presence of REP was confirmed as a strong negative prognostic factor; median overall survival (OS) in patients with REP was 10.7 vs. 18.7 months and 2-year survival was 15.6% vs. 37.7% (hazard ratio HR 0.53 for those without REP; p = 0.007). Interestingly, the REP occurrence effect on survival outcome was significantly different in younger patients (≤ 50 years) and older patients (> 50 years) for OS (p = 0.047) and non-significantly for PFS (p = 0.341). In younger patients, REP was a stronger negative prognostic factor, probably due to more aggressive behavior. Patients with REP who were indicated for the Stupp regimen had longer OS compared to radiotherapy alone (median OS 16.0 vs 7.5; HR = 0.5, p = 0.022; 2-year survival 22.3% vs. 5.6%). The interval between surgery and the initiation of radiotherapy were not prognostic in either the entire cohort or in patients with REP. CONCLUSION: Especially in the subgroup of patients without radical resection, one may recommend as early initiation of radiotherapy as possible. The phenomenon of REP should be recognized as an integral part of stratification factors in future prospective clinical trials enrolling patients before initiation of radiotherapy.

1st Department of Pathology St Anne's University Hospital and Faculty of Medicine Masaryk University 656 91 Brno Czech Republic

Central European Institute of Technology Masaryk University Kamenice 5 625 00 Brno Czech Republic

Department of Biology Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Comprehensive Cancer Care Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Comprehensive Cancer Care Masaryk Memorial Cancer Institute 656 53 Brno Czech Republic

Department of Neurosurgery St Anne's University Hospital Brno 656 91 Brno Czech Republic

Department of Neurosurgery St Anne's University Hospital Brno Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Neurosurgery University Hospital Brno and Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Pathological Physiology Faculty of Medicine Gamma Delta T Cell Laboratory Masaryk University 625 00 Brno Czech Republic

Department of Pathology University Hospital Brno and Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Radiation Oncology Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Radiation Oncology Masaryk Memorial Cancer Institute 656 53 Brno Czech Republic

Department of Radiology Masaryk Memorial Cancer Institute 656 53 Brno Czech Republic

Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Research Center for Applied Molecular Oncology Masaryk Memorial Cancer Institute 656 53 Brno Czech Republic

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