L Klobukowski1, A Falkov2, C Chelimo3, S E Fogh4. 1. Auckland City Hospital, Grafton, Auckland, New Zealand. Electronic address: lukaszk@adhb.govt.nz. 2. Auckland City Hospital, Grafton, Auckland, New Zealand; Auckland Radiation Oncology, Epsom, Auckland, New Zealand. 3. Department of Paediatrics, School of Medicine, University of Auckland, Auckland, New Zealand. 4. Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
Abstract
AIMS: After radical treatment, most high-grade gliomas (HGG) recur locally. Upon recurrence, no standard treatment exists. Options include re-resection, salvage systemic therapy and re-irradiation. This retrospective study evaluated patients who underwent re-irradiation for recurrent HGGs and assessed prognostic factors and their influence on management. MATERIALS AND METHODS: Eighty-two patients who underwent re-irradiation for HGG from 2009 to 2014 were retrospectively identified. Re-irradiation consisted of either standard three-dimensional conformal, intensity-modulated radiotherapy or highly conformal stereotactic radiotherapy using mostly volumetric modulated arc therapy. Patient survival from re-irradiation was the primary end point. Survival was estimated via the Kaplan-Meier method with differences assessed using the Log-rank test; hazard ratios were estimated using Cox regression analysis. RESULTS: The median overall survival from re-irradiation was 9.5 months. Re-irradiation, to a median dose of 35 Gy in 10 fractions, was well tolerated: 4% developed grade 3 toxicity, no patients experienced grade ≥4 or radionecrosis. In the multivariate analysis, factors significantly associated with increased survival included: longer duration from initial radiotherapy, better performance status at re-irradiation of 0-1 versus ≥2, unifocal versus multifocal recurrence and higher total re-irradiation dose (≥35 Gy versus <35 Gy). Re-resection, salvage systemic therapy and age were unrelated to survival. CONCLUSION: Patients with recurrent HGG tolerated re-irradiation well with minimal toxicity. Those patients in good prognostic groups, including good performance status can achieve durable control, suggesting managing patients with regular magnetic resonance imaging surveillance post-radical treatment, identifying early radiological progression and instituting salvage therapy when performance status is best.
AIMS: After radical treatment, most high-grade gliomas (HGG) recur locally. Upon recurrence, no standard treatment exists. Options include re-resection, salvage systemic therapy and re-irradiation. This retrospective study evaluated patients who underwent re-irradiation for recurrent HGGs and assessed prognostic factors and their influence on management. MATERIALS AND METHODS: Eighty-two patients who underwent re-irradiation for HGG from 2009 to 2014 were retrospectively identified. Re-irradiation consisted of either standard three-dimensional conformal, intensity-modulated radiotherapy or highly conformal stereotactic radiotherapy using mostly volumetric modulated arc therapy. Patient survival from re-irradiation was the primary end point. Survival was estimated via the Kaplan-Meier method with differences assessed using the Log-rank test; hazard ratios were estimated using Cox regression analysis. RESULTS: The median overall survival from re-irradiation was 9.5 months. Re-irradiation, to a median dose of 35 Gy in 10 fractions, was well tolerated: 4% developed grade 3 toxicity, no patients experienced grade ≥4 or radionecrosis. In the multivariate analysis, factors significantly associated with increased survival included: longer duration from initial radiotherapy, better performance status at re-irradiation of 0-1 versus ≥2, unifocal versus multifocal recurrence and higher total re-irradiation dose (≥35 Gy versus <35 Gy). Re-resection, salvage systemic therapy and age were unrelated to survival. CONCLUSION:Patients with recurrent HGG tolerated re-irradiation well with minimal toxicity. Those patients in good prognostic groups, including good performance status can achieve durable control, suggesting managing patients with regular magnetic resonance imaging surveillance post-radical treatment, identifying early radiological progression and instituting salvage therapy when performance status is best.