Survival gain with re-Op/RT for recurred high-grade gliomas depends upon risk groups

Chun, Sangmin; Park, Shin Young; Kim, Jin Wook; Kim, Tae Min; Choi, Seung Hong; Lee, Sang Kun; Kim, Il Han

doi:10.1016/j.radonc.2018.05.024

Cited by 18 publications

(13 citation statements)

References 25 publications

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“…A significant benefit for patients who received an RT after second surgery was found (median OS after second surgery 8.5 vs. 13.4 months) [36]. This finding is in line with other reports [37][38][39]. Importantly, the indication for a second RT is re-thought currently.…”

Section: Recurrent Gliomasupporting

confidence: 83%

The algorithms of adjuvant therapy in gliomas and their effect on survival

Straube¹,

Schmidt‐Graf²,

Wiestler³

et al. 2019

J Neurosurg Sci

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The treatment of gliomas became more sophisticated during the last decades. As by now, adjuvant treatment after maximum safe resection is considered an important and effective treatment strategy in most gliomas, yet the decision is based on several factors. This review summarizes the available evidence for the current adjuvant treatment algorithms with a focus on the impact on the survival of glioma patients. The review is based on the current guidelines, but it also includes new insights which have not yet been included into the official guidelines.

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Section: Recurrent Gliomasupporting

confidence: 83%

The algorithms of adjuvant therapy in gliomas and their effect on survival

Straube¹,

Schmidt‐Graf²,

Wiestler³

et al. 2019

J Neurosurg Sci

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“…In re-irradiation series radiation necrosis is observed with high frequency, but this complication is not so common when re-irradiation is performed with SRT. In a study which investigated the role of salvage SRT in 84 patients, the authors did not observe any radiation necrosis [43]. In our study, salvage treatment with SRT was well tolerated, and no grade III/IV treatment-related toxicity was noted throughout the follow-up period.…”

Section: Discussionsupporting

confidence: 40%

Stereotactic Radiotherapy in Recurrent Glioblastoma: A Valid Salvage Treatment Option

Yaprak

Isik

Gemici

et al. 2020

Stereotact Funct Neurosurg

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Background: Glioblastoma (GBM) is a dismal disease. Recurrence is inevitable despite initial surgery and postoperative temozolomide (TMZ) and radiotherapy. Salvage surgery is the standard treatment in selected patients. Chemotherapy, biological agents, and re-irradiation are other treatment approaches available. Stereotactic radiotherapy (SRT) is nowadays a common treatment as a salvage treatment option. Materials and Methods:We reviewed the files of 132 GBM cases treated between 2010 and 2018. All patients received TMZ and radiotherapy after surgery or biopsy. Among the patients who had recurrence, we identified 42 cases treated with salvage SRT. The CyberKnife robotic system was used to administer SRT. Results: While the median follow-up time for all patients was 16 months (range 1-123), the median followup time for patients treated with SRT after initial diagnosis was 26.5 months (range 9-123). The median follow-up time after SRT was 10 months (range 2-107). SRT was performed

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“…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]. Three risk factors (age >50 years, WHO grade IV, and unmethylated promoter of MGMT) were significantly associated with poor OS in multivariate analysis.…”

Section: Re-rt Alonementioning

confidence: 99%

“…Among 56 patients with recurrent GBL with time to recurrence >6 months, re-Op/RT with 45 Gy/25 fx (EQD2 of 42.8 Gy) was delivered to PTV having 8 mm margin from GTV in 33 patients with cumulative median EQD2 of 99.3 Gy (range, 85.5 to 106.9 Gy). The median PFS was significantly better (8.9 vs. 3.3 months; p = 0.031) compared to re-Op alone while the OS was only slightly better (20.6 vs. 15 months; p = 0.2) [57]. There was no grade ≥3 toxicity.…”

Section: Re-operation Prior To Re-irradiation (Re-op/rt)mentioning

confidence: 99%

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

Kim

2019

Radiat Oncol J

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Despite recent innovation in treatment techniques and subsequently improved outcomes, the majority of glioblastoma (GBL) have relapses, especially in locoregional areas. Local re-irradiation (re-RT) has been established as a feasible option for recurrent GBL of all ages with safety, tolerability, and effectiveness both in survival and quality of life regardless of fractionation schedule. To keep adverse effects under acceptable range, cumulative dose limit in equivalent dose at 2 Gy fractions by the linear-quadratic model at α/β = 2 for normal brain tissue (EQD2) with narrow margin should be observed and single/hypofractionated re-RT should be undertaken very carefully to recurrent tumor with large volume or adjacent to the brainstem. Promising outcome of re-operation (re-Op) plus re-RT (re-Op/RT) need to be validated and result from re-RT with temozolomide/bevacizumab (TMZ/BV) or new strategy is expected. Development of new-concept prognostic scoring or risk group is required to select patients properly and make use of predictive biomarkers such as O(6)-methylguanine-DNA methyltransferase (MGMT) promotor methylation that influence outcomes of re-RT, re-Op/RT, or re-RT with TMZ/BV.

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Survival gain with re-Op/RT for recurred high-grade gliomas depends upon risk groups

Cited by 18 publications

References 25 publications

The algorithms of adjuvant therapy in gliomas and their effect on survival

The algorithms of adjuvant therapy in gliomas and their effect on survival

Stereotactic Radiotherapy in Recurrent Glioblastoma: A Valid Salvage Treatment Option

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

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