Impact of chronotherapy and time-of-day on surgical and adjuvant outcomes in glioblastoma and mixed high-grade glioma patients: a systematic review

Available evidence suggests that treatment time-of-day may be associated with modest and context-dependent differences in adjuvant therapy outcomes in glioblastoma. Signals favoring morning temozolomide administration and afternoon radiotherapy are biologically plausible but inconsistent, while current data do not support a clinically meaningful effect of surgical timing. These findings should be considered hypothesis-generating, underscoring the need for prospective, biomarker-guided chronotherapy trials before clinical implementation.