Kerstin A Kessel1,2, Josefine Hesse1, Christoph Straube1, Claus Zimmer3, Friederike Schmidt-Graf4, Jürgen Schlegel5, Bernhard Meyer6, Stephanie E Combs1,2. 1. a Department of Radiation Oncology , Technische Universität München (TUM) , Munich , Germany. 2. b Department of Radiation Sciences (DRS) , Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München , Neuherberg , Germany. 3. c Department of Neuroradiology , Technical University of Munich , Munich , Germany. 4. d Department of Neurology , Technical University of Munich , Munich , Germany. 5. e Department of Neuropathology , Technical University of Munich , Munich , Germany. 6. f Department of Neurosurgery , Technical University of Munich , Munich , Germany.
Abstract
BACKGROUND: Re-irradiation (Re-RT) is offered widely in clinical routine, and has been established as a key element in the treatment of recurrent gliomas. At our center, generally re-resection is performed widely by an experienced neurosurgical team. Thus, Re-RT mostly offered to patients with macroscopic residuals or irresectable lesions, is applied later compared to other centers. Therefore, we sought to validate the Combs Prognostic Score developed in 2012 using our independent patient cohort. PATIENTS AND METHODS: We included 199 patients treated from 2002 until April 2016 for recurrent glioma at the Department of Radiation Oncology at the Klinikum Rechts der Isar, Munich. Different concepts of Re-RT were applied. RESULTS: Median follow-up after Re-RT was 2.5 months. Median overall survival (OS) after Re-RT was 7.9 months for WHO IV gliomas, 11.3 months for WHO III gliomas, and 13.6 months for low-grade gliomas (WHO I/II). Univariate analyses confirmed the prognostic factors primary histology (p = 0.001), age (p = 0.002), and time between primary radiotherapy and Re-RT (p < 0.001). We also tested Karnofsky Performance Score (KPS), gender, and neurological symptoms before Re-RT as well as planning target volume and found only KPS also significant at p < 0.001. Comparing the prognostic score groups, the outcome was highly statistically significant at p < 0.001. CONCLUSION: In our analysis, we validated the Combs Prognostic Score. Validation in this independent large patient cohort confirms the significance of the score for glioma recurrences. Thus, the role of the Combs Prognostic Score might be an essential component of future clinical decision making and patient stratification.
BACKGROUND: Re-irradiation (Re-RT) is offered widely in clinical routine, and has been established as a key element in the treatment of recurrent gliomas. At our center, generally re-resection is performed widely by an experienced neurosurgical team. Thus, Re-RT mostly offered to patients with macroscopic residuals or irresectable lesions, is applied later compared to other centers. Therefore, we sought to validate the Combs Prognostic Score developed in 2012 using our independent patient cohort. PATIENTS AND METHODS: We included 199 patients treated from 2002 until April 2016 for recurrent glioma at the Department of Radiation Oncology at the Klinikum Rechts der Isar, Munich. Different concepts of Re-RT were applied. RESULTS: Median follow-up after Re-RT was 2.5 months. Median overall survival (OS) after Re-RT was 7.9 months for WHO IV gliomas, 11.3 months for WHO III gliomas, and 13.6 months for low-grade gliomas (WHO I/II). Univariate analyses confirmed the prognostic factors primary histology (p = 0.001), age (p = 0.002), and time between primary radiotherapy and Re-RT (p < 0.001). We also tested Karnofsky Performance Score (KPS), gender, and neurological symptoms before Re-RT as well as planning target volume and found only KPS also significant at p < 0.001. Comparing the prognostic score groups, the outcome was highly statistically significant at p < 0.001. CONCLUSION: In our analysis, we validated the Combs Prognostic Score. Validation in this independent large patient cohort confirms the significance of the score for glioma recurrences. Thus, the role of the Combs Prognostic Score might be an essential component of future clinical decision making and patient stratification.
Authors: Jan C Peeken; Josefine Hesse; Bernhard Haller; Kerstin A Kessel; Fridtjof Nüsslin; Stephanie E Combs Journal: Strahlenther Onkol Date: 2018-02-13 Impact factor: 3.621
Authors: Stephanie E Combs; Maximilian Niyazi; Sebastian Adeberg; Nina Bougatf; David Kaul; Daniel F Fleischmann; Arne Gruen; Emmanouil Fokas; Claus M Rödel; Franziska Eckert; Frank Paulsen; Oliver Oehlke; Anca-Ligia Grosu; Annekatrin Seidlitz; Annika Lattermann; Mechthild Krause; Michael Baumann; Maja Guberina; Martin Stuschke; Volker Budach; Claus Belka; Jürgen Debus; Kerstin A Kessel Journal: Cancer Med Date: 2018-03-23 Impact factor: 4.452
Authors: Kerstin A Kessel; Josefine Hesse; Christoph Straube; Claus Zimmer; Friederike Schmidt-Graf; Jürgen Schlegel; Bernhard Meyer; Stephanie E Combs Journal: PLoS One Date: 2017-07-05 Impact factor: 3.240