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Open Access 01-05-2022 | Glioblastoma | Original Article

Comparison of carbon ion and photon reirradiation for recurrent glioblastoma

Authors: F. S. Lautenschlaeger, R. Dumke, M. Schymalla, H. Hauswald, B. Carl, M. Stein, U. Keber, A. Jensen, R. Engenhart-Cabillic, F. Eberle

Published in: Strahlentherapie und Onkologie | Issue 5/2022

Abstract

Purpose

Purpose of this study was to investigate overall survival in recurrent glioblastoma treated with either carbon ion reirradiation or photon reirradiation.

Materials and methods

In this retrospective study we evaluated 78 consecutive patients with recurrent IDH (Isocitrate dehydrogenase)-wildtype glioblastoma (38 patients carbon ion re-radiotherapy, 40 patients photon re-radiotherapy) treated with either carbon ion reirradiation or stereotactic photon reirradiation. 45 Gy (RBE; 15 fractions) carbon ion reirradiation (CIRT) or 39 Gy (13 fractions) photon reirradiation (FSRT) was administered, respectively. Overall survival was investigated with respect to histological, clinical, and epidemiological features. Kaplan–Meier and multivariate Cox statistics were calculated. A propensity score-matched analysis of the FSRT and CIRT groups using variables from a validated prognosis score was carried out.

Results

The type of reirradiation (CIRT vs. FSRT) significantly influenced overall survival—8.0 months vs. 6.5 months (univariate: p = 0.046)—and remained an independent prognostic factor in multivariate analysis (p = 0.017). Propensity score-adjusted analysis with CIRT versus FSRT as the dependent variable yielded a significant overall survival advantage for the CIRT group (median OS 8.9 versus 7.2 months, p = 0.041, 1‑year survival 29 versus 10%). Adverse events (AE) were evaluated for both subgroups. For the FSRT group no toxicity ≥ grade 4 occurred. For the CIRT subgroup no grade 5 AE occurred, but 1 patient developed a grade 4 radionecrosis. We encountered 4 grade 3 toxicities. One patient developed a zoster at the trunk, 2 progressed in their paresis, and 1 featured progressive dysesthesia.

Conclusion

In conclusion, carbon ion treatment is a safe and feasible treatment option for recurrent glioblastoma. Due to the retrospective nature of the study and two different dose levels for CIRT or FSRT, the improved outcome in CIRT reirradiation might be an effect of higher biological impact from carbon ions or a simple dose-escalation effect. This hypothesis needs prospective testing in larger patient cohorts. A prospective phase III randomized trial is in preparation at our center.

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Title: Comparison of carbon ion and photon reirradiation for recurrent glioblastoma
Authors: F. S. Lautenschlaeger
R. Dumke
M. Schymalla
H. Hauswald
B. Carl
M. Stein
U. Keber
A. Jensen
R. Engenhart-Cabillic
F. Eberle
Publication date: 01-05-2022
Publisher: Springer Berlin Heidelberg
Keywords: Glioblastoma
Glioma
Particle Therapy
Glioma
Glioblastoma
Radiotherapy
Glioblastoma
Glioma
Published in: Strahlentherapie und Onkologie / Issue 5/2022
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-021-01844-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Comparison of carbon ion and photon reirradiation for recurrent glioblastoma

Abstract

Purpose

Materials and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

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