LAUSR

to biopsy only or different levels of partial resection could be less influenced by hypoxia and might be more prone to RT benefits. Conversely, the maximal safe resection is established as a predictor for longer survival. Therefore, the biological causes of radioresistance and its interactions with time for chemoradiation are yet to be clarified and hypoxia remains to some extent a reasonable explanation for this enigma. Third, more important than the potential radiobiological explanation seems to be the patient’s clinic profile and the physician’s judgment. Once called “the waiting time paradox” [2], this trend has been mostly attributed to the physician’s judgment, expediting treatment for higher risk patients, i.e., low performance status or those undergoing biopsy only, ultimately interfering in the survival curve. However, the authors were unable to retrieve such prognostic factors and it is not clear the effect size of these factors in the survival curves, especially for the patients treated earlier. Finally, it seems hazardous to use the article title as a final statement. The study by Nathan et al. [1] must be added to a long list of controversies [3] and caution must be taken when applying its results into practice. In a time when demand is increasing and supply is finite, the inadequate judgment of the study title by health government authorities and private insurance providers may throw patients into a danger zone where RT is deliberated delayed in the name of a (not plausible) benefit. Therefore, we suggest the first conclusion’s sentence ‘earlier initiation of postoperative radiation with concomitant Temozolomide for patients with HGG is not associated with increased survival’ as an accurate and reliable title. A slight semantic change nevertheless a huge meaning difference. To the Editor,