Re-irradiation as salvage treatment in recurrent glioblastoma: A comprehensive literature review to provide practical answers to frequently asked questions

Scoccianti, Silvia; Francolini, Giulio; Carta, G; Greto, Daniela; Detti, Beatrice; Simontacchi, Gabriele; Visani, Luca; Baki, M.; Poggesi, Linda; Bonomo, Pierluigi; Mangoni, Monica; Desideri, Isacco; Pallotta, S.; Livi, Lorenzo

doi:10.1016/j.critrevonc.2018.03.024

Cited by 52 publications

(32 citation statements)

References 52 publications

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“…A literature review by Soccianti et al found a median OS range of 7.9 to 13 months for available studies. 16 The study with the highest median OS was by Kong et al, with an OS of 13 months. 17 Of note, Kong et al used a stereotactic radiosurgery approach with a median single-fraction dose of 16 Gy.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with previous studies evaluating the role of reirradiation in patients with recurrent GBM, our current analysis results compare favorably. 8 , 9 , 12 , 13 , 15 , 16 The largest GBM reirradiation analysis is by Fogh et al, who analyzed 147 patients with recurrent high-grade gliomas undergoing hypofractionated photon RT. 8 Of the 147 patients, 105 had GBM.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcomes in Patients with Recurrent Glioblastoma Treated with Proton Beam Therapy Reirradiation: Analysis of the Multi-Institutional Proton Collaborative Group Registry

Saeed

Khairnar

Sharma

et al. 2020

Advances in Radiation Oncology

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Purpose As a means of limiting normal tissue toxicity, proton-beam therapy (PBT) is an emerging radiation modality for glioblastoma (GBM) reirradiation. However, data for recurrent GBM treated with PBT reirradiation is limited. Therefore, we analyzed treatment patterns, toxicities, and clinical outcomes of patients with recurrent GBM treated with PBT reirradiation using the multi-institutional Proton Collaborative Group registry. Methods and Materials Prospectively collected data for patients with recurrent GBM who underwent PBT while enrolled in Proton Collaborative Group study 01-009 (NCT01255748) were analyzed. We evaluated overall survival (OS), progression-free survival (PFS), and toxicity. Toxicities were scored per the Common Terminology Criteria for Adverse Events, version 4.0. Descriptive statistics were used to report patient, tumor, and treatment characteristics. Multivariable analyses (MVA) for toxicity were conducted using logistic regression. The Kaplan-Meier method was used to calculate OS and PFS. MVA for OS and PFS was conducted using Cox proportional-hazards models. The SAS statistical software was used for the analysis. Results We identified 45 recurrent patients with GBM who underwent PBT reirradiation between 2012 and 2018. The median time between initial GBM diagnosis and recurrence was 20.2 months. The median follow-up time from PBT reirradiation was 10.7 months. Median PFS was 13.9 months (95% confidence interval [CI], 8.23-20.0 months) and median OS was 14.2 months (95% CI, 9.6-16.9 months) after PBT reirradiation. One patient experienced an acute grade 3 toxicity, 4 patients experienced late grade 3 toxicity (no grade ≥4 toxicities). MVA revealed that prior surgery was associated with a 91.3% decreased hazard of death (hazard ratio: 0.087; 95% CI, 0.02-0.42; P < .01). No explanatory variables were associated with PFS or grade 3 toxicities. Conclusions This is the largest series to date reporting outcomes for PBT reirradiation of patients with recurrent GBM. Our analysis indicates that PBT is well tolerated and offers efficacy rates comparable with previously reported photon reirradiation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes in Patients with Recurrent Glioblastoma Treated with Proton Beam Therapy Reirradiation: Analysis of the Multi-Institutional Proton Collaborative Group Registry

Saeed

Khairnar

Sharma

et al. 2020

Advances in Radiation Oncology

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“…The role of local therapy is also not well established, being reserved for patients with significant neurological symptoms when the disease and patients are operable ( 12 ). In the last decade, the use of re-irradiation has significantly increased mainly because of improvements in the accuracy of image-guided radiotherapy and knowledge regarding radiation tolerability by the brain ( 19 ). Several radiation schedules have been used with total doses ranging from 24-36 Gy in 4-6 fractions ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Patterns of recurrence and outcomes of glioblastoma multiforme treated with chemoradiation and adjuvant temozolomide

Faustino¹,

Viani²,

Hamamura³

2020

Clinics

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OBJECTIVES: To assess the patterns of failure and prognostic factors in Brazilian patients with glioblastoma multiforme (GBM) treated with radiotherapy (RT) and concurrent and adjuvant temozolomide (TMZ). METHODS: Patients with diagnosed GBM post-resection received postoperative RT. TMZ was administered concurrently at 75 mg/m 2 /day for 28 consecutive days and adjuvant therapy at 150-200 mg/m 2 /day for 5 days every 28 days. Radiographic failure was defined as any new T1-enhancing lesion or biopsy-confirmed progressive enhancement inside of the radiation field. When possible, patients with recurrence were salvaged with metronomic TMZ, either in combination with a local treatment or alone (surgery or re-irradiation). Several prognostic factors were evaluated for overall survival (OS). Univariate and multivariate analyses were performed to identify significant factors. A p -value <0.05 was considered significant. RESULTS: This study included 50 patients. The median follow-up time was 21 months. The median RT dose was 60 Gy and all patients received concomitant TMZ. During follow-up, 41 (83.6%) failures were observed, including 34 (83%) in-field, 4 (9.7%) marginal, and 3 (7.3%) distant failures. Metronomic TMZ was used as salvage treatment in 22 (44%) cases and in combination with local treatment in 12 (24%) cases. The median OS and progression-free survival times for the entire cohort were 17 and 9 months, respectively. In univariate analysis, the following factors were significant for better OS: maximal surgical resection ( p =0.03), Karnofsky Performance Score (KPS)>70 at diagnosis ( p =0.01), metronomic TMZ treatment ( p =0.038), recursive partitioning analysis class III ( p =0.03), and time to failure >9 months ( p =0.0001). In multivariate analysis, the following factors remained significant for better OS: metronomic TMZ ( p =0.01) and time to failure >9 months ( p =0.0001). CONCLUSION: The median OS of Brazilian patients with GBM treated with RT and TMZ was satisfactory. Although TMZ therapy has become the standard of care for patients with newly diagnosed GBM, the recurrence rate is extremely high. Metronomic TMZ as salvage treatment improved survival in these patients.

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“…The OS ranged from 7.5 m [7] to 10 m. [12] The PFS ranged from 4.6 m [6] to 7 m. [12] The most frequent side effect was radio-necrosis, with a maximum incidence of 31.3% reported by Hsieh et al [10] Considering the poor prognosis of recurrent GBM, severe side effects with a risk of <3% were arbitrarily defined as acceptable toxicity. [13] Therefore, the above data indicate that stereotactic radiosurgery is feasible for patients with small volumes (<12.5 mL), and the average prescription dose should remain ranging from 12 to 15 Gy, because higher doses can lead to severe side effects.…”

Section: Discussionmentioning

confidence: 99%

Conventionally fractionated stereotactic radiotherapy (CFRT) in combination with dose-dense temozolomide (TMZ) in relapsed malignant glioma

Qie

Liu²,

Shi³

et al. 2019

Medicine

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Rationale:At present, there is no uniform consensus on the treatment of recurrent glioblastoma, especially the re-irradiation dose and temozolomide (TMZ) dose. The literature on the treatment of recurrent glioblastoma (GBM) by conventionally fractionated stereotactic radiotherapy (CFRT) is even rarer.Patient concerns:A 44-year-old woman was admitted to our hospital for residual tumor after reoperation.Diagnoses:Postoperative pathological diagnosis was GBM, WHO grade IV. The brain magnetic resonance imaging re-examination showed abnormal enhancement around the local operative region after resection of the left frontal lobe tumor, and there was presence of residual tumor.Interventions:The patient was treated with reoperation followed by re-irradiation plus dose-dense TMZ to achieve complete remission.Outcomes:Complete remission was observed at the end of radiotherapy and at the 1 month follow-up after radiotherapy.Lessons:This study suggests that CFRT plus dose-dense TMZ might be a feasible option for the treatment in relapsed malignant glioma patients with good general condition.

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Re-irradiation as salvage treatment in recurrent glioblastoma: A comprehensive literature review to provide practical answers to frequently asked questions

Cited by 52 publications

References 52 publications

Clinical Outcomes in Patients with Recurrent Glioblastoma Treated with Proton Beam Therapy Reirradiation: Analysis of the Multi-Institutional Proton Collaborative Group Registry

Clinical Outcomes in Patients with Recurrent Glioblastoma Treated with Proton Beam Therapy Reirradiation: Analysis of the Multi-Institutional Proton Collaborative Group Registry

Patterns of recurrence and outcomes of glioblastoma multiforme treated with chemoradiation and adjuvant temozolomide

Conventionally fractionated stereotactic radiotherapy (CFRT) in combination with dose-dense temozolomide (TMZ) in relapsed malignant glioma

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