Pierina Navarria1, Giuseppe Minniti2, Elena Clerici3, Stefano Tomatis3, Valentina Pinzi4, Patrizia Ciammella5, Marco Galaverni5, Dante Amelio6, Daniele Scartoni6, Silvia Scoccianti7, Marco Krengli8, Laura Masini8, Lorena Draghini9, Ernesto Maranzano9, Valentina Borzillo10, Paolo Muto10, Fabio Ferrarese11, Laura Fariselli4, Lorenzo Livi7, Francesco Pasqualetti12, Alba Fiorentino13, Filippo Alongi13, Michela Buglione di Monale14, Stefano Magrini14, Marta Scorsetti3,15. 1. Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy. pierina.navarria@humanitas.it. 2. Advanced Radiotherapy Center, UPMC San Pietro FBF, Roma, Italy. 3. Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy. 4. Radiotherapy Unit, Istituto Neurologico Fondazione "Carlo Besta", Milan, Italy. 5. Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera Arcispedale S Maria Nuova, Reggio Emilia, Italy. 6. Proton Therapy Center, Azienda Provinciale per I Servizi Sanitari (APSS), Trento, Italy. 7. Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. 8. Radiotherapy Unit, Department of Translation Medicine, University of Piemonte Orientale, Novara, Italy. 9. Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy. 10. UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori -Fondazione "Giovanni Pascale", Naples, Italy. 11. Radiation Therapy, Ospedale Ca' Foncello di Treviso, Treviso, Italy. 12. Radiation Oncology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. 13. Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy. 14. Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy. 15. Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Abstract
INTRODUCTION: The prognosis of glioma is dismal, and almost all patients relapsed. At recurrence time, several treatment options are considered, but to date there is no a standard of care. The Neurooncology Study Group of the Italian Association of Radiation Oncology (AIRO) collected clinical data regarding a large series of recurrent glioma patients who underwent re-irradiation (re-RT) in Italy. METHODS: Data regarding 300 recurrent glioma patients treated from May 2002 to November 2017, were analyzed. All patients underwent re-RT. Surgical resection, followed by re-RT with concomitant and adjuvant chemotherapy was performed. Clinical outcome was evaluated by neurological examination and brain MRI performed, 1 month after radiation therapy and then every 3 months. RESULTS: Re-irradiation was performed at a median interval time (IT) of 16 months from the first RT. Surgical resection before re-RT was performed in 19% of patients, concomitant temozolomide (TMZ) in 16.3%, and maintenance chemotherapy in 29%. Total doses ranged from 9 Gy to 52.5 Gy, with a median biological effective dose of 43 Gy. The median, 1, 2 year OS were 9.7 months, 41% and 17.7%. Low grade glioma histology (p ≪ 0.01), IT > 12 months (p = 0.001), KPS > 70 (p = 0.004), younger age (p = 0.001), high total doses delivered (p = 0.04), and combined treatment performed (p = 0.0008) were recorded as conditioning survival. CONCLUSION: our data underline re-RT as a safe and feasible treatment with limited rate of toxicity, and a combined ones as a better option for selected patients. The identification of a BED threshold able to obtain a greater benefit on OS, can help in designing future prospective studies.
INTRODUCTION: The prognosis of glioma is dismal, and almost all patients relapsed. At recurrence time, several treatment options are considered, but to date there is no a standard of care. The Neurooncology Study Group of the Italian Association of Radiation Oncology (AIRO) collected clinical data regarding a large series of recurrent gliomapatients who underwent re-irradiation (re-RT) in Italy. METHODS: Data regarding 300 recurrent gliomapatients treated from May 2002 to November 2017, were analyzed. All patients underwent re-RT. Surgical resection, followed by re-RT with concomitant and adjuvant chemotherapy was performed. Clinical outcome was evaluated by neurological examination and brain MRI performed, 1 month after radiation therapy and then every 3 months. RESULTS: Re-irradiation was performed at a median interval time (IT) of 16 months from the first RT. Surgical resection before re-RT was performed in 19% of patients, concomitant temozolomide (TMZ) in 16.3%, and maintenance chemotherapy in 29%. Total doses ranged from 9 Gy to 52.5 Gy, with a median biological effective dose of 43 Gy. The median, 1, 2 year OS were 9.7 months, 41% and 17.7%. Low grade glioma histology (p ≪ 0.01), IT > 12 months (p = 0.001), KPS > 70 (p = 0.004), younger age (p = 0.001), high total doses delivered (p = 0.04), and combined treatment performed (p = 0.0008) were recorded as conditioning survival. CONCLUSION: our data underline re-RT as a safe and feasible treatment with limited rate of toxicity, and a combined ones as a better option for selected patients. The identification of a BED threshold able to obtain a greater benefit on OS, can help in designing future prospective studies.
Authors: Patrick Y Wen; David R Macdonald; David A Reardon; Timothy F Cloughesy; A Gregory Sorensen; Evanthia Galanis; John Degroot; Wolfgang Wick; Mark R Gilbert; Andrew B Lassman; Christina Tsien; Tom Mikkelsen; Eric T Wong; Marc C Chamberlain; Roger Stupp; Kathleen R Lamborn; Michael A Vogelbaum; Martin J van den Bent; Susan M Chang Journal: J Clin Oncol Date: 2010-03-15 Impact factor: 44.544
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Authors: Roger Stupp; Monika E Hegi; Warren P Mason; Martin J van den Bent; Martin J B Taphoorn; Robert C Janzer; Samuel K Ludwin; Anouk Allgeier; Barbara Fisher; Karl Belanger; Peter Hau; Alba A Brandes; Johanna Gijtenbeek; Christine Marosi; Charles J Vecht; Karima Mokhtari; Pieter Wesseling; Salvador Villa; Elizabeth Eisenhauer; Thierry Gorlia; Michael Weller; Denis Lacombe; J Gregory Cairncross; René-Olivier Mirimanoff Journal: Lancet Oncol Date: 2009-03-09 Impact factor: 41.316
Authors: Kelly C Paradis; Charles Mayo; Dawn Owen; Daniel E Spratt; Jason Hearn; Benjamin Rosen; Rojano Kashani; Jean Moran; Daniel S Tatro; Whitney Beeler; Karen Vineberg; Dylan C Smith; Martha M Matuszak Journal: Adv Radiat Oncol Date: 2019-06-08
Authors: Fabiana Gregucci; Ilaria Bonaparte; Alessia Surgo; Morena Caliandro; Roberta Carbonara; Maria Paola Ciliberti; Alberto Aga; Francesco Berloco; Marina De Masi; Christian De Pascali; Federica Fragnoli; Chiara Indellicati; Rosalinda Parabita; Giuseppe Sanfrancesco; Luciana Branà; Annarita Ciocia; Domenico Curci; Pietro Guida; Alba Fiorentino Journal: J Pers Med Date: 2021-12-12