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Clinical and Translational Oncology
Published in: Clinical and Translational Oncology 5/2019

01-05-2019 | Research Article

Re-irradiation of recurrent glioblastoma as part of a sequential multimodality treatment concept

Authors: E. Bräutigam, C. Lampl, C. Track, C. Nieder, J. Pichler, J. Hammer, H. Geinitz

Published in: Clinical and Translational Oncology | Issue 5/2019

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Abstract

Purpose

The aim of this retrospective study was to evaluate survival outcomes in well-performing, mainly, young patients receiving a sequence of all available therapeutic options for relapsed glioblastoma, including re-irradiation.

Methods

We performed a retrospective analysis of 27 patients irradiated twice for glioblastoma between 2008 and 2016. In the first line, all had surgical treatment of the tumor followed by radiotherapy with a total dose of 60 Gy and temozolomide. All re-irradiated patients were treated with a total dose of 36 Gy in 12 fractions. The endpoints were death from glioblastoma or any cause, and toxicity after re-irradiation.

Results

The median follow-up of survivors was 35.6 months. At the time of analysis, 25 patients had died. The median time between first and second radiotherapy was 18.9 months (6.1–58.4). Re-irradiation was performed at different time points of first, second and third progression. The median overall survival after first diagnosis was 39.2 months. Five years after first surgery, nearly 20% of the patients were alive.

Conclusion

Carefully planned re-irradiation of the brain is a safe therapy for recurrent glioblastoma. Younger and well-performing patients benefit from all available therapy options. Every patient should be discussed in a multidisciplinary setting at each time point of tumor progression. Further prospective studies are needed to define the optimal time, dose and volume of re-irradiation.
Literature
1.
Stupp R, Mason WP, Van den Bent M, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987–96.CrossRef
2.
Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomized phase III study: 5-years analysis of the EORTC-NCIC trial. Lancet Oncol. 2009;10:459–66.CrossRefPubMed
3.
Bauman GS, Sneed PK, Wara WM, et al. Reirradiation of primary CNS tumors. Int J Radiat Oncol Biol Phys. 1996;36(433):441.
4.
5.
Ernst-Stecken A, Ganslandt O, Lambrecht U, et al. Survival and quality of life after hypofractionated stereotactic radiotherapy for recurrent malignant glioma. J Neurooncol. 2007;81:287–94.CrossRefPubMed
6.
Henke G, Paulsen F, Steinbach JP, et al. Hypofractionated reirradiation for recurrent malignant glioma. Strahlenther Onkol. 2009;185:113–9.CrossRefPubMed
7.
Vordermark D, Kolbl O, Ruprecht K, et al. Hypofractionated stereotactic re-irradiation: treatment option in recurrent malignant glioma. BMC Cancer. 2005;5:55.CrossRefPubMedPubMedCentral
8.
Niyazi M, Siefert A, Schwarz SB, et al. Therapeutic options for recurrent malignant glioma. Radiother Oncol. 2011;98:1–14.CrossRefPubMed
9.
Niyazi M, Ganswindt U, Schwarz SB, et al. Irradiation and bevacizumab in high-grade glioma retreatment setting. Int J Radiat Oncol Biol Phys. 2010;82:67–76.CrossRefPubMed
10.
Combs SE, Gutwein S, Thilmann C, et al. Stereotactically guided fractionated re-irradiation in recurrent glioblastoma multiforme. J Neurooncol. 2005;74:167–71.CrossRefPubMed
11.
Combs SE, Thilmann C, Edler L, et al. Efficacy of fractionated stereotactic reirradiation in recurrent gliomas: long-term results in 172 patients treated in a single institution. J Clin Oncol. 2005;23:8863–9.CrossRefPubMed
12.
Cho KH, Hall WA, Gerbi BJ, et al. Single dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas. Int J Radiat Oncol Biol Phys. 1999;45:1133–41.CrossRefPubMed
13.
Nieder C, Nestle U, Niewald M, et al. Hyperfractionated reiiradiation for malignant gliomas. Front Radiat Ther Oncol. 1999;33:150–7.CrossRef
14.
Nieder C, Astner ST, Mehta MP, et al. Improvement, clinical course, and quality of life after palliative radiotherapy for recurrent glioblastoma. Am J Clin Oncol. 2008;31:300–5.CrossRefPubMed
15.
Stöckelmaier L, Renovanz M, König J, et al. Therapy for recurrent high-grade gliomas: results of a prospective multicenter study on health-related quality of life. World Neurosurg. 2017;102:383–99.CrossRefPubMed
16.
Sulman EP, Ismaila N, Armstrong TS, et al. Radiation therapy for glioblastoma: American Society of clinical oncology clinical practice guideline endorsement of the American Society for radiation oncology guideline. J Clin Oncol. 2017;35:361–9.CrossRefPubMed
17.
Mayer R, Sminia P. Reirradiation tolerance of the human brain. Int J Radiat Oncol Biol Phys. 2008;70:1350–60.CrossRefPubMed
18.
Kessel KA, Hesse J, Straube C, et al. Modification and optimization of an established prognostic score after re-irradiation of recurrent glioma. PLoS One. 2017;12:e0180457.CrossRefPubMedPubMedCentral
19.
International Commission on Radiation Units and Measurements. Prescribing, recording and reporting photon beam therapy. Report 50, Bethesda, MD: ICRU (1993).
20.
International Commission on Radiation Units and Measurements. Prescribing, recording and reporting photon beam therapy. Report 62 (Supplement to ICRU Report 50) Bethesda, MD: ICRU (1999).
21.
Fokas E, Wacker U, Gross MW, et al. Hypofractionated stereotactic reirradiation of recurrent glioblastomas: a beneficial treatment option after high-dose radiotherapy? Strahlenther Onkol. 2009;185:235–40.CrossRefPubMed
22.
Mizumoto M, Okumura T, Ishikawa E, et al. Reirradiation for recurrent malignant brain tumor with radiotherapy or proton beam therapy. Technical considerations based on experience at a single institution. Strahlenther Onkol. 2013;189:656–63.CrossRefPubMed
23.
24.
Scorsetti M, Navarria P, Pessina F, et al. Multimodality therapy approaches, local and systemic treatment, compared with chemotherapy alone in recurrent glioblastoma. BMC Cancer. 2015;15:486.CrossRefPubMedPubMedCentral
25.
Robin AM, Lee I, Kalkanis SN. Reoperation for recurrent glioblastoma multiforme. Neurosurg Clin N Am. 2017;28:407–28.CrossRefPubMed
26.
Stupp R, Wong ET, Kanner AA, et al. NovoTTF-100A versus physician’s choice chemotherapy in recurrent glioblastoma: a randomised phase III trial of a novel treatment modality. Eur J Cancer. 2012;48:2192–202.CrossRefPubMed
27.
28.
Nieder C, Andratschke NH, Grosu AL. Re-irradiation for recurrent primary brain tumors. Anticancer Res. 2016;36:4985–95.CrossRefPubMed
29.
Niyazi M, Söhn M, Schwarz SB, et al. Radiation treatment parameters for re-irradiation of malignant glioma. Strahlenther Onkol. 2012;188:328–33.CrossRefPubMed
30.
Metadata
Title
Re-irradiation of recurrent glioblastoma as part of a sequential multimodality treatment concept
Authors
E. Bräutigam
C. Lampl
C. Track
C. Nieder
J. Pichler
J. Hammer
H. Geinitz
Publication date
01-05-2019
Publisher
Springer International Publishing
Published in
Clinical and Translational Oncology / Issue 5/2019
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-018-1957-6

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