Timing of re-irradiation in recurrent high-grade gliomas: a single institution study

• Published in: Journal of neuro-oncology 2018-07, Vol.138 (3), p.571-579
• Main Authors: Zemlin, A., Märtens, B., Wiese, B., Merten, R., Steinmann, D.
• Format: Article
• Language: English
• Subjects: Chemoradiotherapy; Clinical Study; Diagnosis; Glioblastoma; Glioma; Medicine; Medicine & Public Health; Neurology; Oncology; Patients; Radiation therapy; Surgery; Survival; Tumors
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1007/s11060-018-2824-6

There is no standard treatment available for recurrent high-grade gliomas. This monoinstitutional retrospective analysis evaluates the differences in overall survival and progression-free survival in patients according to the timing of re-irradiation. Patients suffering from a glioblastoma who received re-irradiation for recurrence were evaluated retrospectively. The median overall survival (OS) and the median progression-free survival were compared with different treatment options and within various time periods. From January 2007 until March 2015, 41 patients suffering from recurrent high-grade gliomas received re-irradiation [median dose of 30.6 Gy (range 20–40 Gy) in median 4 Gy fractions (range 1.8–5 Gy)] in our institution after initial postoperative irradiation or combined radiochemotherapy. The OS in this population was 34 months, and the OS after recurrence (OS-R) was 13 months. After diagnosis of recurrence, patients underwent additional surgical resection after a median of 1.2 months, received a second-line systemic therapy after 2.2 months with or without re-irradiation after 5.7 months. Growth of the tumour was assessed 4.3 months after the start of re-irradiation. The OS after the second surgical resection was 12.2 months, 11.7 months after the start of the second-line systemic therapy, and 6.7 months after the start of re-irradiation. The OS-R was not significantly correlated with the start of re-irradiation after a diagnosis of recurrence or the time period after the previous surgery. At this institution, re-irradiation was performed later compared to other treatment options. However, select patients could benefit from irradiation at an earlier time point. A precise time point should still be evaluated on an individual basis due to the patient’s diverse conditions.