Mihir Shanker1,2, Benjamin Chua3, Catherine Bettington1,3, Matthew C Foote1,2, Mark B Pinkham1,2. 1. The University of Queensland, Faculty of Medicine, Australia. 2. Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Australia. 3. Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Abstract
BACKGROUND: Re-irradiation may be considered for select patients with recurrent high-grade glioma. Treatment techniques include conformal radiotherapy employing conventional fractionation, hypofractionated stereotactic radiotherapy (FSRT), and single-fraction stereotactic radiosurgery (SRS). METHODS: A pooled, population-weighted, multiple linear regression analysis of publications from 1992 to 2016 was performed to evaluate the relationships between re-irradiation technique and median overall survival (OS) and radionecrosis outcomes. RESULTS: Seventy published articles were analyzed, yielding a total of 3302 patients. Across all studies, initial treatment was external beam radiotherapy to a median dose of 60 Gy in 30 fractions, with or without concurrent chemotherapy. On multivariate analysis, there was a significant correlation between OS and radiotherapy technique after adjusting for age, re-irradiation biologically equivalent dose (EQD2), interval between initial and repeat radiotherapy, and treatment volume (P < .0001). Adjusted mean OS was 12.2 months (95% CI, 11.8-12.5) after SRS, 10.1 months (95% CI, 9.7-10.5) after FSRT, and 8.9 months (95% CI, 8.4-9.4) after conventional fractionation. There was also a significant association between radionecrosis and treatment technique after adjusting for age, re-irradiation EQD2, interval, and volume (P < .0001). Radionecrosis rate was 7.1% (95% CI, 6.6-7.7) after FSRT, 6.1% (95% CI, 5.6-6.6) after SRS, and 1.1% (95% CI, 0.5-1.7) after conventional fractionation. CONCLUSIONS: The published literature suggests that OS is highest after re-irradiation using SRS, followed by FSRT and conventionally fractionated radiotherapy. Whether this represents superiority of the treatment technique or an uncontrolled selection bias is uncertain. The risk of radionecrosis was low for all modalities overall. Re-irradiation is a feasible option in appropriately selected patients.
BACKGROUND: Re-irradiation may be considered for select patients with recurrent high-grade glioma. Treatment techniques include conformal radiotherapy employing conventional fractionation, hypofractionated stereotactic radiotherapy (FSRT), and single-fraction stereotactic radiosurgery (SRS). METHODS: A pooled, population-weighted, multiple linear regression analysis of publications from 1992 to 2016 was performed to evaluate the relationships between re-irradiation technique and median overall survival (OS) and radionecrosis outcomes. RESULTS: Seventy published articles were analyzed, yielding a total of 3302 patients. Across all studies, initial treatment was external beam radiotherapy to a median dose of 60 Gy in 30 fractions, with or without concurrent chemotherapy. On multivariate analysis, there was a significant correlation between OS and radiotherapy technique after adjusting for age, re-irradiation biologically equivalent dose (EQD2), interval between initial and repeat radiotherapy, and treatment volume (P < .0001). Adjusted mean OS was 12.2 months (95% CI, 11.8-12.5) after SRS, 10.1 months (95% CI, 9.7-10.5) after FSRT, and 8.9 months (95% CI, 8.4-9.4) after conventional fractionation. There was also a significant association between radionecrosis and treatment technique after adjusting for age, re-irradiation EQD2, interval, and volume (P < .0001). Radionecrosis rate was 7.1% (95% CI, 6.6-7.7) after FSRT, 6.1% (95% CI, 5.6-6.6) after SRS, and 1.1% (95% CI, 0.5-1.7) after conventional fractionation. CONCLUSIONS: The published literature suggests that OS is highest after re-irradiation using SRS, followed by FSRT and conventionally fractionated radiotherapy. Whether this represents superiority of the treatment technique or an uncontrolled selection bias is uncertain. The risk of radionecrosis was low for all modalities overall. Re-irradiation is a feasible option in appropriately selected patients.
Authors: Jarrod B Adkison; Wolfgang Tomé; Songwon Seo; Gregory M Richards; H Ian Robins; Karl Rassmussen; James S Welsh; Peter A Mahler; Steven P Howard Journal: Int J Radiat Oncol Biol Phys Date: 2010-05-14 Impact factor: 7.038
Authors: E Shaw; C Scott; L Souhami; R Dinapoli; R Kline; J Loeffler; N Farnan Journal: Int J Radiat Oncol Biol Phys Date: 2000-05-01 Impact factor: 7.038
Authors: Michael Brada; Sally Stenning; Rhian Gabe; Lindsay C Thompson; David Levy; Roy Rampling; Sara Erridge; Frank Saran; Rao Gattamaneni; Kirsten Hopkins; Sarah Beall; V Peter Collins; Siow-Ming Lee Journal: J Clin Oncol Date: 2010-09-20 Impact factor: 44.544
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: Tugce Kutuk; Ranjini Tolakanahalli; Nicole C McAllister; Matthew D Hall; Martin C Tom; Muni Rubens; Haley Appel; Alonso N Gutierrez; Yazmin Odia; Alexander Mohler; Manmeet S Ahluwalia; Minesh P Mehta; Rupesh Kotecha Journal: Cancers (Basel) Date: 2022-06-15 Impact factor: 6.575
Authors: Daniel P Kulinich; John P Sheppard; Thien Nguyen; Aditya M Kondajji; Ansley Unterberger; Courtney Duong; Adam Enomoto; Kunal Patel; Isaac Yang Journal: Acta Neurochir (Wien) Date: 2021-04-02 Impact factor: 2.216