BACKGROUND: Despite advances in modern therapy, high-grade gliomas continue to portend a dismal prognosis and nearly all patients will experience relapse. Unfortunately, salvage options remain limited. In this study, we assessed outcomes for patients with recurrent gliomas treated with reirradiation. METHODS: We retrospectively identified 48 glioma patients treated with reirradiation between 2013 and 2016. All had radiographic or pathologic evidence of recurrence. Prognostic factors were abstracted from the electronic medical record. RESULTS: Initial surgery included biopsy in 15, subtotal resection in 21, and gross total resection in 12. Initial chemotherapy included temozolomide (TMZ) in 31, TMZ+dasatinib in 7, TMZ+vorinostat in 3, and procarbazine, lomustine, and vincristine in 2. The median dose of primary radiotherapy was 60 Gy delivered in 30 fractions. Median overall survival (OS) and progression-free survival (PFS) from initial diagnosis were 3.2 and 1.7 years, respectively. A total of 36 patients failed salvage bevacizumab before reirradiation. Salvage surgery was performed before reirradiation in 21 patients. Median time to reirradiation was 1.7 years. Median follow-up was 13.7 months from reirradiation. Concurrent systemic therapy was given in 33 patients (bevacizumab in 27, TMZ in 8, and lomustine in 2). Median PFS and OS after reirradiation were 3.2 and 6.3 months, respectively. Radionecrosis occurred in 4 patients and no radionecrosis was seen in patients receiving concurrent bevacizumab with reirradiation (0% vs 19%, P = .03). CONCLUSIONS: Reirradiation may result in delayed tumor progression with acceptable toxicity. Prospective trials are needed to determine the impact of reirradiation on tumor progression and quality of life.
BACKGROUND: Despite advances in modern therapy, high-grade gliomas continue to portend a dismal prognosis and nearly all patients will experience relapse. Unfortunately, salvage options remain limited. In this study, we assessed outcomes for patients with recurrent gliomas treated with reirradiation. METHODS: We retrospectively identified 48 glioma patients treated with reirradiation between 2013 and 2016. All had radiographic or pathologic evidence of recurrence. Prognostic factors were abstracted from the electronic medical record. RESULTS: Initial surgery included biopsy in 15, subtotal resection in 21, and gross total resection in 12. Initial chemotherapy included temozolomide (TMZ) in 31, TMZ+dasatinib in 7, TMZ+vorinostat in 3, and procarbazine, lomustine, and vincristine in 2. The median dose of primary radiotherapy was 60 Gy delivered in 30 fractions. Median overall survival (OS) and progression-free survival (PFS) from initial diagnosis were 3.2 and 1.7 years, respectively. A total of 36 patients failed salvage bevacizumab before reirradiation. Salvage surgery was performed before reirradiation in 21 patients. Median time to reirradiation was 1.7 years. Median follow-up was 13.7 months from reirradiation. Concurrent systemic therapy was given in 33 patients (bevacizumab in 27, TMZ in 8, and lomustine in 2). Median PFS and OS after reirradiation were 3.2 and 6.3 months, respectively. Radionecrosis occurred in 4 patients and no radionecrosis was seen in patients receiving concurrent bevacizumab with reirradiation (0% vs 19%, P = .03). CONCLUSIONS: Reirradiation may result in delayed tumor progression with acceptable toxicity. Prospective trials are needed to determine the impact of reirradiation on tumor progression and quality of life.
Authors: R S Hudes; B W Corn; M Werner-Wasik; D Andrews; J Rosenstock; L Thoron; B Downes; W J Curran Journal: Int J Radiat Oncol Biol Phys Date: 1999-01-15 Impact factor: 7.038
Authors: George Voynov; Seth Kaufman; Theodore Hong; Arthur Pinkerton; Richard Simon; Robert Dowsett Journal: Am J Clin Oncol Date: 2002-12 Impact factor: 2.339
Authors: H S Friedman; W P Petros; A H Friedman; L J Schaaf; T Kerby; J Lawyer; M Parry; P J Houghton; S Lovell; K Rasheed; T Cloughsey; E S Stewart; O M Colvin; J M Provenzale; R E McLendon; D D Bigner; I Cokgor; M Haglund; J Rich; D Ashley; J Malczyn; G L Elfring; L L Miller Journal: J Clin Oncol Date: 1999-05 Impact factor: 44.544
Authors: Timothy F Cloughesy; Emese Filka; John Kuhn; Gillian Nelson; Fairooz Kabbinavar; Henry Friedman; Langdon L Miller; Gary L Elfring Journal: Cancer Date: 2003-05-01 Impact factor: 6.860
Authors: Roger Stupp; Warren P Mason; Martin J van den Bent; Michael Weller; Barbara Fisher; Martin J B Taphoorn; Karl Belanger; Alba A Brandes; Christine Marosi; Ulrich Bogdahn; Jürgen Curschmann; Robert C Janzer; Samuel K Ludwin; Thierry Gorlia; Anouk Allgeier; Denis Lacombe; J Gregory Cairncross; Elizabeth Eisenhauer; René O Mirimanoff Journal: N Engl J Med Date: 2005-03-10 Impact factor: 91.245
Authors: Michael D Prados; W K Alfred Yung; Howard A Fine; Harry S Greenberg; Larry Junck; Susan M Chang; M Kelly Nicholas; H Ian Robins; Minesh P Mehta; Karen L Fink; Kurt A Jaeckle; John Kuhn; Kenneth R Hess; S Clifford Schold Journal: Neuro Oncol Date: 2004-01 Impact factor: 12.300
Authors: Dirk Vordermark; Oliver Kölbl; Klemens Ruprecht; Giles H Vince; Klaus Bratengeier; Michael Flentje Journal: BMC Cancer Date: 2005-05-30 Impact factor: 4.430
Authors: William G Breen; Ryan S Youland; Sharmila Giri; Sawyer B Jacobson; Deanna H Pafundi; Paul D Brown; Christopher H Hunt; Anita Mahajan; Michael W Ruff; Sani H Kizilbash; Joon H Uhm; David M Routman; Jamecca E Jones; Debra H Brinkmann; Nadia N Laack Journal: J Neurooncol Date: 2022-05-18 Impact factor: 4.130