Prognostic parameters and outcome after re-irradiation for progressive glioblastoma

Abstract

The favourable results regarding overall survival are probably due to patient selection for re-irradiation. If technically feasible, stereotactic radiosurgery or hypofractionated regimes should be preferred. In this highly selected re-irradiation cohort, only some of the well-known prognostic factors of the primary tumour setting were found to influence overall survival significantly. In contrast, also some patients presenting with unfavourable predictive parameters showed an encouraging course of disease and thus should not be excluded from re-irradiation.

Improved survival of Swedish glioblastoma patients treated according to Stupp

“…A recent study shows that re‐irradiation with single dose stereotactic or hypofractionated radiosurgery regimens have favorable results compared to normofractioned re‐irradiation in overall survival. In a highly selected re‐irradiated cohort, the median overall survival was 28.8 months …”

Low Fraction Size Re-irradiation for Large Volume Recurrence of Glial Tumours

“…In contrast to these small target volumes for re-RT with SRS techniques, lower doses to larger volumes could be applied safely with acceptable efficacy, which was confirmed by the first meta-analysis on re-irradiation published by Kazmi et al [17]. However, highly divergent Another recent study revealed that OS after salvage SRS or hypofractionated RT (HFRT) does not significantly (p = 0.06) differs from that after conventionally fractionated re-RT, and the trend towards better OS probably related to smaller target volume [34]. Analysis in a retrospective review has not shown any differences in OS after stereotactic or conventionally fractionated re-RT [35].…”

“…Krauze et al reported a mOS of 6 months after re-irradiation of recurrent glioma with median 30 Gy [ 33 ]. Another recent study revealed that OS after salvage SRS or hypofractionated RT (HFRT) does not significantly (p = 0.06) differs from that after conventionally fractionated re-RT, and the trend towards better OS probably related to smaller target volume [ 34 ]. Analysis in a retrospective review has not shown any differences in OS after stereotactic or conventionally fractionated re-RT [ 35 ].…”

Appraisal of re-irradiation for the recurrent glioblastoma in the era of MGMT promotor methylation

“…Regarding various fractionation schedules of re-RT, it was revealed that OS after salvage SRS or hypofractionated RT (HFRT) was marginally (p = 0.06) better than that after conventionally fractionated re-RT presumably from small target volume [33]. Another study has suggested similar survival after re-RT when using standard RT compared with stereotactic techniques [28].…”

“…Influence of MGMT methylation status on survival after re-RT has been recently appraised. The median OS of recurrent GBL after re-RT is affected by MGMT methylation (10.7 vs. 8.5 months, p = 0.06) [33]. It is noteworthy that a recent study on prognostic factors after re-RT firstly puts an emphasis on the importance of MGMT methylation status [57].…”