A Retrospective Review of Re-irradiating Patients' Recurrent High-grade Gliomas

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) 2018-09, Vol.30 (9), p.563-570
• Main Authors: Klobukowski, L., Falkov, A., Chelimo, C., Fogh, S.E.
• Format: Article
• Language: English
• Subjects: Anaplastic glioma; glioblastoma; radiotherapy; re-irradiation; recurrent
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2018.05.004

After radical treatment, most high-grade gliomas (HGG) recur locally. Upon recurrence, no standard treatment exists. Options include re-resection, salvage systemic therapy and re-irradiation. This retrospective study evaluated patients who underwent re-irradiation for recurrent HGGs and assessed prognostic factors and their influence on management. Eighty-two patients who underwent re-irradiation for HGG from 2009 to 2014 were retrospectively identified. Re-irradiation consisted of either standard three-dimensional conformal, intensity-modulated radiotherapy or highly conformal stereotactic radiotherapy using mostly volumetric modulated arc therapy. Patient survival from re-irradiation was the primary end point. Survival was estimated via the Kaplan–Meier method with differences assessed using the Log-rank test; hazard ratios were estimated using Cox regression analysis. The median overall survival from re-irradiation was 9.5 months. Re-irradiation, to a median dose of 35 Gy in 10 fractions, was well tolerated: 4% developed grade 3 toxicity, no patients experienced grade ≥4 or radionecrosis. In the multivariate analysis, factors significantly associated with increased survival included: longer duration from initial radiotherapy, better performance status at re-irradiation of 0–1 versus ≥2, unifocal versus multifocal recurrence and higher total re-irradiation dose (≥35 Gy versus