Stephanie E Combs1,2,3, Kerstin A Kessel1,2, Josefine Hesse1, Christoph Straube1, Claus Zimmer4, Friederike Schmidt-Graf5, Jürgen Schlegel6, Jens Gempt7, Bernhard Meyer7. 1. Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany. 2. Institute of Innovative Radiotherapy ( i RT), Helmholtz Zentrum München, Neuherberg, Germany. 3. Deutsches Konsortium für Translationale Krebsforschung (dktk), Partner Site Munich, Munich, Germany. 4. Department of Neuroradiology, Technical University of Munich (TUM), Munich, Germany. 5. Department of Neurology, Technical University of Munich (TUM), Munich, Germany. 6. Department of Neuropathology, Technical University of Munich (TUM), Munich, Germany. 7. Department of Neurosurgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.
Abstract
BACKGROUND: Generally, re-irradiation (Re-RT) is offered to patients with glioma recurrences with macroscopic lesions. Results are discussed controversially, and some centers postulate limited benefit of Re-RT. Re-RT is generally offered to tumors up to 4 cm in diameter. Re-resection is also discussed controversially; however, recent studies have shown significant benefit. OBJECTIVE: To combine proactive re-resection and early Re-RT in patients with recurrent glioma. METHODS: We included 108 patients treated between 2002 and 2016 for recurrent glioma. All patients underwent surgical resection for recurrence; Re-RT was applied with a median dose of 37.5 Gy (range 25 Gy-57Gy/equivalent dose in 2Gy fractions [EQD2]) with high-precision techniques. All patients were followed prospectively in an interdisciplinary follow-up program. RESULTS: Median follow-up after Re-RT was 7 mo. Median survival after surgery and Re-RT was 12 mo (range 1-102 mo). Complete resection had a significant impact on the outcome (P = .03). The strongest predictors of outcome were MGMT-promotor methylation and Karnofsky Performance Score and time interval between primary and second RT. CONCLUSION: Proactive resection of tumor recurrences combined with early Re-RT conveys into promising outcome in recurrent glioma. Complete resection and early Re-RT lead to improved survival. Thus, moving Re-RT to an earlier timepoint during the treatment of recurrent glioma, eg after complete macroscopic removal of the tumor, may be crucial for treatment optimization. Using advanced RT techniques, side effects are low. Currently, this concept is evaluated in the GLIOCAVE/NOA 17 trial.
BACKGROUND: Generally, re-irradiation (Re-RT) is offered to patients with glioma recurrences with macroscopic lesions. Results are discussed controversially, and some centers postulate limited benefit of Re-RT. Re-RT is generally offered to tumors up to 4 cm in diameter. Re-resection is also discussed controversially; however, recent studies have shown significant benefit. OBJECTIVE: To combine proactive re-resection and early Re-RT in patients with recurrent glioma. METHODS: We included 108 patients treated between 2002 and 2016 for recurrent glioma. All patients underwent surgical resection for recurrence; Re-RT was applied with a median dose of 37.5 Gy (range 25 Gy-57Gy/equivalent dose in 2Gy fractions [EQD2]) with high-precision techniques. All patients were followed prospectively in an interdisciplinary follow-up program. RESULTS: Median follow-up after Re-RT was 7 mo. Median survival after surgery and Re-RT was 12 mo (range 1-102 mo). Complete resection had a significant impact on the outcome (P = .03). The strongest predictors of outcome were MGMT-promotor methylation and Karnofsky Performance Score and time interval between primary and second RT. CONCLUSION: Proactive resection of tumor recurrences combined with early Re-RT conveys into promising outcome in recurrent glioma. Complete resection and early Re-RT lead to improved survival. Thus, moving Re-RT to an earlier timepoint during the treatment of recurrent glioma, eg after complete macroscopic removal of the tumor, may be crucial for treatment optimization. Using advanced RT techniques, side effects are low. Currently, this concept is evaluated in the GLIOCAVE/NOA 17 trial.
Authors: I Stiefel; C Schröder; S Tanadini-Lang; I Pytko; E Vu; R J Klement; M Guckenberger; N Andratschke Journal: Clin Transl Radiat Oncol Date: 2021-02-04
Authors: Colette J Shen; Megan N Kummerlowe; Kristin J Redmond; Juan Carlos Martinez-Gutierrez; Syed Muhammad Usama; Matthias Holdhoff; Stuart A Grossman; John J Laterra; Roy E Strowd; Lawrence R Kleinberg Journal: Adv Radiat Oncol Date: 2018-07-10