High-dose salvage re-irradiation in recurrent/progressive adult diffuse gliomas: development of a novel prognostic scoring system

Gupta, Tejpal; Maitre, Priyamvada; Chatterjee, Abhishek; Dasgupta, Archya; Moiyadi, Aliasgar; Shetty, Prakash; Epari, Sridhar; Sahay, Ayushi; Patil, Vijay; Krishnatry, Rahul; Sastri, Goda Jayant; Jalali, Rakesh

doi:10.1016/j.canrad.2022.01.004

Cited by 3 publications

(2 citation statements)

References 43 publications

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“…Patients with a shorter interval of disease recurrence, poor performance status, or disseminated disease are associated with poor prognosis, with the doubtful role of aggressive treatment regimens, including ReRT. Major deciding factors to consider in ReRT are time from the course of RT, tumor volume at recurrence, doses delivered to organs at risk, performance status, and molecular characteristics [10,11].…”

Section: Introductionmentioning

confidence: 99%

Imaging-Based Patterns of Failure following Re-Irradiation for Recurrent/Progressive High-Grade Glioma

Datta

Dasgupta

Chatterjee

et al. 2023

JPM

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Background: Re-irradiation (ReRT) is an effective treatment modality in appropriately selected patients with recurrent/progressive high-grade glioma (HGG). The literature is limited regarding recurrence patterns following ReRT, which was investigated in the current study. Methods: Patients with available radiation (RT) contours, dosimetry, and imaging-based evidence of recurrence were included in the retrospective study. All patients were treated with fractionated focal conformal RT. Recurrence was detected on imaging with magnetic resonance imaging (MRI) and/ or amino-acid positron emission tomography (PET), which was co-registered with the RT planning dataset. Failure patterns were classified as central, marginal, and distant if >80%, 20–80%, or <20% of the recurrence volumes were within 95% isodose lines, respectively. Results: Thirty-seven patients were included in the current analysis. A total of 92% of patients had undergone surgery before ReRT, and 84% received chemotherapy. The median time to recurrence was 9 months. Central, marginal, and distant failures were seen in 27 (73%), 4 (11%), and 6 (16%) patients, respectively. None of the patient-, disease-, or treatment-related factors were significantly different across different recurrence patterns. Conclusion: Failures are seen predominantly within the high-dose region following ReRT in recurrent/ progressive HGG.

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Section: Introductionmentioning

confidence: 99%

Imaging-Based Patterns of Failure following Re-Irradiation for Recurrent/Progressive High-Grade Glioma

Datta

Dasgupta

Chatterjee

et al. 2023

JPM

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“…Disease recurrence is encountered during or in a few months after completion of maintenance chemotherapy in GBM depicting aggressive tumor biology; or after several years of treatment completion in IDH-mutant gliomas. Also, following radiation (RT), treatment-related changes in the form of radionecrosis (RN) can be encountered in a proportion of patients, which can mimic progressive disease (9)(10)(11). The spectrum of RN ranges from asymptomatic to severe neurological worsening, with the majority responding to medical decompressive therapy, with some refractory cases requiring surgery or anti-angiogenic therapy with Bevacizumab (12,13).…”

Section: Introductionmentioning

confidence: 99%

The complementary role of MRI and FET PET in high-grade gliomas to differentiate recurrence from radionecrosis

et al. 2023

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BackgroundConventional magnetic resonance imaging (MRI) has limitations in differentiating tumor recurrence (TR) from radionecrosis (RN) in high grade gliomas (HGG), which can present with morphologically similar appearances. Multiparametric advanced MR sequences and Positron Emission Tomography (PET) with amino acid tracers can aid in diagnosing tumor metabolism. The role of both modalities on an individual basis and combined performances were investigated in the current study.Materials and MethodsPatients with HGG with MRI and PET within three weeks were included in the retrospective analysis. The multiparametric MRI included T1-contrast, T2-weighted sequences, perfusion, diffusion, and spectroscopy. MRI was interpreted by neuroradiologist without using information from PET imaging. 18F-Fluoroethyl-Tyrosine (FET) uptake was calculated from the areas of maximum enhancement/suspicion, which was assessed by nuclear medicine physician (having access to MRI to determine tumor-to-white matter ratio over a specific region). A definitive diagnosis of TR or RN was made based on the combination of multidisciplinary joint clinic decisions, histopathological examination, and clinic-radiological follow-up as applicable.Results62 patients were included in the study between July 2018 and August 2021. The histology during initial diagnosis was glioblastoma, oligodendroglioma, and astrocytoma in 43, 7, and 6, respectively, while in 6, no definitive histological characterization was available. The median time from radiation (RT) was 23 months. 46 and 16 patients had TR and RN recurrence, respectively. Sensitivity, specificity, and accuracy using MRI were 98, 77, and 94%, respectively. Using PET imaging with T/W cut-off of 2.65, sensitivity, specificity, and accuracy were 79, 84, 80%, respectively. The best results were obtained using both imaging combined with sensitivity, specificity, and accuracy of 98, 100, and 98%, respectively.ConclusionCombined imaging with MRI and FET-PET offers multiparametric assessment of glioma recurrence that is correlative and complimentary, with higher accuracy and clinical value.

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Re-irradiation for recurrent high-grade glioma: an analysis of prognostic factors for survival and predictors of radiation necrosis

et al. 2023

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High-dose salvage re-irradiation in recurrent/progressive adult diffuse gliomas: development of a novel prognostic scoring system

Cited by 3 publications

References 43 publications

Imaging-Based Patterns of Failure following Re-Irradiation for Recurrent/Progressive High-Grade Glioma

Imaging-Based Patterns of Failure following Re-Irradiation for Recurrent/Progressive High-Grade Glioma

The complementary role of MRI and FET PET in high-grade gliomas to differentiate recurrence from radionecrosis

Re-irradiation for recurrent high-grade glioma: an analysis of prognostic factors for survival and predictors of radiation necrosis

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