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Patterns of re-irradiation for recurrent gliomas and validation of a prognostic score
•Median OS of patients eligible for ReRT is 9.7 months in our series.•Registered toxicity rates are low (severe acute toxicity 13% and radionecrosis 8%).•The reirradiation risk score of Niyazi et al. was successfully validated.•Collaboration among medical centers is necessary to achieve optimized tr...
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| Published in: | Radiotherapy and oncology 2019-01, Vol.130, p.156-163 |
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| creator | Post, Cathalijne C.B. Kramer, Miranda C.A. Smid, Ernst J. van der Weide, Hiske L. Kleynen, Catharina E. Heesters, Mart A.A.M. Verhoeff, Joost J.C. |
| description | •Median OS of patients eligible for ReRT is 9.7 months in our series.•Registered toxicity rates are low (severe acute toxicity 13% and radionecrosis 8%).•The reirradiation risk score of Niyazi et al. was successfully validated.•Collaboration among medical centers is necessary to achieve optimized treatment regimen.
Re-irradiation is a generally accepted method for salvage treatment in patients with recurrent glioma. However, no standard radiation regimen has been defined. This study aims to compare the efficacy and safety of different treatment regimens and to independently externally validate a recently published reirradiation risk score.
We retrospectively analyzed a cohort of patients with recurrent malignant glioma treated with salvage conventionally fractionated (CFRT), hypofractionated (HFRT) or stereotactic radiotherapy (SRT) between 2007 and 2017 at the University Medical Centers in Utrecht and Groningen.
Of the 121 patients included, 60 patients (50%) underwent CFRT, 22 (18%) HFRT and 39 (32%) SRT. The primary tumor was grade II-III in 52 patients and grade IV in 69 patients with median Overall Survival (mOS) since first surgery of 113 [Interquartile range: 53.2–137] and 39.7 [24.6–64.9] months respectively (p |
| doi_str_mv | 10.1016/j.radonc.2018.10.034 |
| format | article |
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Re-irradiation is a generally accepted method for salvage treatment in patients with recurrent glioma. However, no standard radiation regimen has been defined. This study aims to compare the efficacy and safety of different treatment regimens and to independently externally validate a recently published reirradiation risk score.
We retrospectively analyzed a cohort of patients with recurrent malignant glioma treated with salvage conventionally fractionated (CFRT), hypofractionated (HFRT) or stereotactic radiotherapy (SRT) between 2007 and 2017 at the University Medical Centers in Utrecht and Groningen.
Of the 121 patients included, 60 patients (50%) underwent CFRT, 22 (18%) HFRT and 39 (32%) SRT. The primary tumor was grade II-III in 52 patients and grade IV in 69 patients with median Overall Survival (mOS) since first surgery of 113 [Interquartile range: 53.2–137] and 39.7 [24.6–64.9] months respectively (p < 0.01). Overall, mOS from the first day of re-irradiation was 9.7 months [6.5–14.6]. No significant difference in mOS was found between the treatment groups. In multivariate analysis, the Karnofsky performance scale ≥70% (p < 0.01), re-irradiation for first recurrence (p = 0.02), longer time interval between RT start dates (p < 0.01) and smaller planning target volume (p < 0.05) were significant favorable prognostic factors. The reirradiation risk score was validated.
In our series, mOS after reirradiation was sufficient to justify use of this modality. Until a reliable treatment decision tool is developed based on larger retrospective research, the decision for re-irradiation schedule should remain personalized and based on a multidisciplinary evaluation of each patient.</description><identifier>ISSN: 0167-8140</identifier><identifier>EISSN: 1879-0887</identifier><identifier>DOI: 10.1016/j.radonc.2018.10.034</identifier><identifier>PMID: 30446315</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Adult ; Aged ; Brain Neoplasms - mortality ; Brain Neoplasms - pathology ; Brain Neoplasms - radiotherapy ; Dose Fractionation, Radiation ; Female ; Glioma ; Glioma - mortality ; Glioma - pathology ; Glioma - radiotherapy ; Humans ; Male ; Middle Aged ; Neoplasm recurrence, local ; Neoplasm Recurrence, Local - radiotherapy ; Radiosurgery ; Radiotherapy dosage ; Re-Irradiation ; Recurrence ; Retrospective Studies</subject><ispartof>Radiotherapy and oncology, 2019-01, Vol.130, p.156-163</ispartof><rights>2018 Elsevier B.V.</rights><rights>Copyright © 2018 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-57986c1e6786cdf5642f4cecc824197d69da62c765677c0a522de2194d05f963</citedby><cites>FETCH-LOGICAL-c408t-57986c1e6786cdf5642f4cecc824197d69da62c765677c0a522de2194d05f963</cites><orcidid>0000-0003-2534-6887</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30446315$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Post, Cathalijne C.B.</creatorcontrib><creatorcontrib>Kramer, Miranda C.A.</creatorcontrib><creatorcontrib>Smid, Ernst J.</creatorcontrib><creatorcontrib>van der Weide, Hiske L.</creatorcontrib><creatorcontrib>Kleynen, Catharina E.</creatorcontrib><creatorcontrib>Heesters, Mart A.A.M.</creatorcontrib><creatorcontrib>Verhoeff, Joost J.C.</creatorcontrib><title>Patterns of re-irradiation for recurrent gliomas and validation of a prognostic score</title><title>Radiotherapy and oncology</title><addtitle>Radiother Oncol</addtitle><description>•Median OS of patients eligible for ReRT is 9.7 months in our series.•Registered toxicity rates are low (severe acute toxicity 13% and radionecrosis 8%).•The reirradiation risk score of Niyazi et al. was successfully validated.•Collaboration among medical centers is necessary to achieve optimized treatment regimen.
Re-irradiation is a generally accepted method for salvage treatment in patients with recurrent glioma. However, no standard radiation regimen has been defined. This study aims to compare the efficacy and safety of different treatment regimens and to independently externally validate a recently published reirradiation risk score.
We retrospectively analyzed a cohort of patients with recurrent malignant glioma treated with salvage conventionally fractionated (CFRT), hypofractionated (HFRT) or stereotactic radiotherapy (SRT) between 2007 and 2017 at the University Medical Centers in Utrecht and Groningen.
Of the 121 patients included, 60 patients (50%) underwent CFRT, 22 (18%) HFRT and 39 (32%) SRT. The primary tumor was grade II-III in 52 patients and grade IV in 69 patients with median Overall Survival (mOS) since first surgery of 113 [Interquartile range: 53.2–137] and 39.7 [24.6–64.9] months respectively (p < 0.01). Overall, mOS from the first day of re-irradiation was 9.7 months [6.5–14.6]. No significant difference in mOS was found between the treatment groups. In multivariate analysis, the Karnofsky performance scale ≥70% (p < 0.01), re-irradiation for first recurrence (p = 0.02), longer time interval between RT start dates (p < 0.01) and smaller planning target volume (p < 0.05) were significant favorable prognostic factors. The reirradiation risk score was validated.
In our series, mOS after reirradiation was sufficient to justify use of this modality. Until a reliable treatment decision tool is developed based on larger retrospective research, the decision for re-irradiation schedule should remain personalized and based on a multidisciplinary evaluation of each patient.</description><subject>Adult</subject><subject>Aged</subject><subject>Brain Neoplasms - mortality</subject><subject>Brain Neoplasms - pathology</subject><subject>Brain Neoplasms - radiotherapy</subject><subject>Dose Fractionation, Radiation</subject><subject>Female</subject><subject>Glioma</subject><subject>Glioma - mortality</subject><subject>Glioma - pathology</subject><subject>Glioma - radiotherapy</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm recurrence, local</subject><subject>Neoplasm Recurrence, Local - radiotherapy</subject><subject>Radiosurgery</subject><subject>Radiotherapy dosage</subject><subject>Re-Irradiation</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><issn>0167-8140</issn><issn>1879-0887</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kE1LxDAQhoMo7rr6D0R69NKapGnSXgRZ_IIFPaznEJPpkqVt1iRd8N-bpatHTwMvzzvDPAhdE1wQTPjdtvDKuEEXFJM6RQUu2Qmak1o0Oa5rcYrmCRN5TRieoYsQthhjiktxjmYlZoyXpJqjj3cVI_ghZK7NPOTWp61WReuGrHU-RXr0HoaYbTrrehUyNZhsrzprJijVVLbzbjO4EK3OgnYeLtFZq7oAV8e5QOunx_XyJV-9Pb8uH1a5ZriOeSWammsCXKRh2ooz2jINWteUkUYY3hjFqRa84kJorCpKDVDSMIOrtuHlAt1Oa9P9rxFClL0NGrpODeDGICkpK0IpJVVC2YRq70Lw0Mqdt73y35JgefApt3LyKQ8-D2nymWo3xwvjZw_mr_QrMAH3EwDpzb0FL4O2MGgwNqmL0jj7_4Ufp8CIXw</recordid><startdate>201901</startdate><enddate>201901</enddate><creator>Post, Cathalijne C.B.</creator><creator>Kramer, Miranda C.A.</creator><creator>Smid, Ernst J.</creator><creator>van der Weide, Hiske L.</creator><creator>Kleynen, Catharina E.</creator><creator>Heesters, Mart A.A.M.</creator><creator>Verhoeff, Joost J.C.</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2534-6887</orcidid></search><sort><creationdate>201901</creationdate><title>Patterns of re-irradiation for recurrent gliomas and validation of a prognostic score</title><author>Post, Cathalijne C.B. ; Kramer, Miranda C.A. ; Smid, Ernst J. ; van der Weide, Hiske L. ; Kleynen, Catharina E. ; Heesters, Mart A.A.M. ; Verhoeff, Joost J.C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-57986c1e6786cdf5642f4cecc824197d69da62c765677c0a522de2194d05f963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Brain Neoplasms - mortality</topic><topic>Brain Neoplasms - pathology</topic><topic>Brain Neoplasms - radiotherapy</topic><topic>Dose Fractionation, Radiation</topic><topic>Female</topic><topic>Glioma</topic><topic>Glioma - mortality</topic><topic>Glioma - pathology</topic><topic>Glioma - radiotherapy</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm recurrence, local</topic><topic>Neoplasm Recurrence, Local - radiotherapy</topic><topic>Radiosurgery</topic><topic>Radiotherapy dosage</topic><topic>Re-Irradiation</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Post, Cathalijne C.B.</creatorcontrib><creatorcontrib>Kramer, Miranda C.A.</creatorcontrib><creatorcontrib>Smid, Ernst J.</creatorcontrib><creatorcontrib>van der Weide, Hiske L.</creatorcontrib><creatorcontrib>Kleynen, Catharina E.</creatorcontrib><creatorcontrib>Heesters, Mart A.A.M.</creatorcontrib><creatorcontrib>Verhoeff, Joost J.C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Radiotherapy and oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Post, Cathalijne C.B.</au><au>Kramer, Miranda C.A.</au><au>Smid, Ernst J.</au><au>van der Weide, Hiske L.</au><au>Kleynen, Catharina E.</au><au>Heesters, Mart A.A.M.</au><au>Verhoeff, Joost J.C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patterns of re-irradiation for recurrent gliomas and validation of a prognostic score</atitle><jtitle>Radiotherapy and oncology</jtitle><addtitle>Radiother Oncol</addtitle><date>2019-01</date><risdate>2019</risdate><volume>130</volume><spage>156</spage><epage>163</epage><pages>156-163</pages><issn>0167-8140</issn><eissn>1879-0887</eissn><abstract>•Median OS of patients eligible for ReRT is 9.7 months in our series.•Registered toxicity rates are low (severe acute toxicity 13% and radionecrosis 8%).•The reirradiation risk score of Niyazi et al. was successfully validated.•Collaboration among medical centers is necessary to achieve optimized treatment regimen.
Re-irradiation is a generally accepted method for salvage treatment in patients with recurrent glioma. However, no standard radiation regimen has been defined. This study aims to compare the efficacy and safety of different treatment regimens and to independently externally validate a recently published reirradiation risk score.
We retrospectively analyzed a cohort of patients with recurrent malignant glioma treated with salvage conventionally fractionated (CFRT), hypofractionated (HFRT) or stereotactic radiotherapy (SRT) between 2007 and 2017 at the University Medical Centers in Utrecht and Groningen.
Of the 121 patients included, 60 patients (50%) underwent CFRT, 22 (18%) HFRT and 39 (32%) SRT. The primary tumor was grade II-III in 52 patients and grade IV in 69 patients with median Overall Survival (mOS) since first surgery of 113 [Interquartile range: 53.2–137] and 39.7 [24.6–64.9] months respectively (p < 0.01). Overall, mOS from the first day of re-irradiation was 9.7 months [6.5–14.6]. No significant difference in mOS was found between the treatment groups. In multivariate analysis, the Karnofsky performance scale ≥70% (p < 0.01), re-irradiation for first recurrence (p = 0.02), longer time interval between RT start dates (p < 0.01) and smaller planning target volume (p < 0.05) were significant favorable prognostic factors. The reirradiation risk score was validated.
In our series, mOS after reirradiation was sufficient to justify use of this modality. Until a reliable treatment decision tool is developed based on larger retrospective research, the decision for re-irradiation schedule should remain personalized and based on a multidisciplinary evaluation of each patient.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>30446315</pmid><doi>10.1016/j.radonc.2018.10.034</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-2534-6887</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Radiotherapy and oncology, 2019-01, Vol.130, p.156-163 |
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| subjects | Adult Aged Brain Neoplasms - mortality Brain Neoplasms - pathology Brain Neoplasms - radiotherapy Dose Fractionation, Radiation Female Glioma Glioma - mortality Glioma - pathology Glioma - radiotherapy Humans Male Middle Aged Neoplasm recurrence, local Neoplasm Recurrence, Local - radiotherapy Radiosurgery Radiotherapy dosage Re-Irradiation Recurrence Retrospective Studies |
| title | Patterns of re-irradiation for recurrent gliomas and validation of a prognostic score |
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