Re-irradiation for recurrent glioblastoma multiforme: a critical comparison of different concepts
Standard
Re-irradiation for recurrent glioblastoma multiforme: a critical comparison of different concepts. / Baehr, A; Trog, D; Oertel, M; Welsch, S; Kröger, K; Grauer, O; Haverkamp, U; Eich, H T.
in: STRAHLENTHER ONKOL, Jahrgang 196, Nr. 5, 05.2020, S. 457-464.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Re-irradiation for recurrent glioblastoma multiforme: a critical comparison of different concepts
AU - Baehr, A
AU - Trog, D
AU - Oertel, M
AU - Welsch, S
AU - Kröger, K
AU - Grauer, O
AU - Haverkamp, U
AU - Eich, H T
PY - 2020/5
Y1 - 2020/5
N2 - PURPOSE: Purpose of this study was to investigate outcome and toxicity of re-irradiation for recurrent primary glioblastoma (rGBM). We evaluated a group of patients with rGBM and identical primary treatment comprising adjuvant radiotherapy (30 × 2 Gy) with concurrent temozolomide (TMZ).METHODS: In this retrospective study of 46 patients, all received adjuvant or definitive normofractionated radiotherapy to a pretreated area, some with concurrent chemotherapy. Impact of different clinical, histological, or epidemiological factors on survival and radiation toxicity was reviewed.RESULTS: Of 46 patients, 40 completed the intended therapy. Overall survival (OS) was 20 months (range 6-72 months). Overall survival and progression-free survival after re-irradiation (OS2 and PFS2) were 9.5 and 3.4 months (range 2-40 and 0.7-44 months). Simultaneous systemic therapy improved PFS2 and OS2 (4.3 vs. 2.0, p < 0.001 and 12 vs. 4 months, p = 0.13, respectively). Therapy with TMZ or bevacizumab improved PFS2 vs. nitrosureas (6.6 vs. 2.9, p = 0.03 and 5.1 vs. 2.9 months, p = 0.035, respectively). TMZ also improved PFS2 and OS2 vs. all other systemic therapies (6.6 vs. 4, p < 0.001 and 17 vs. 10 months, p = 0.1). In a subgroup analysis for patients with methylation of the MGMT promoter, doses of >36 Gy as well as TMZ vs. no systemic therapy improved PFS2 (p = 0.045 and p = 0.03, respectively). 27.5% of all patients had no acute toxicity. Three patients with acute and four patients with late grade 3 toxicities were reported.CONCLUSION: Normofractionated radiotherapy is a feasible option for rGBM with a good toxicity profile. Simultaneously applied systemic therapy was associated with improved outcome. For MGMT promoter-methylated histology, higher radiation doses improved survival.
AB - PURPOSE: Purpose of this study was to investigate outcome and toxicity of re-irradiation for recurrent primary glioblastoma (rGBM). We evaluated a group of patients with rGBM and identical primary treatment comprising adjuvant radiotherapy (30 × 2 Gy) with concurrent temozolomide (TMZ).METHODS: In this retrospective study of 46 patients, all received adjuvant or definitive normofractionated radiotherapy to a pretreated area, some with concurrent chemotherapy. Impact of different clinical, histological, or epidemiological factors on survival and radiation toxicity was reviewed.RESULTS: Of 46 patients, 40 completed the intended therapy. Overall survival (OS) was 20 months (range 6-72 months). Overall survival and progression-free survival after re-irradiation (OS2 and PFS2) were 9.5 and 3.4 months (range 2-40 and 0.7-44 months). Simultaneous systemic therapy improved PFS2 and OS2 (4.3 vs. 2.0, p < 0.001 and 12 vs. 4 months, p = 0.13, respectively). Therapy with TMZ or bevacizumab improved PFS2 vs. nitrosureas (6.6 vs. 2.9, p = 0.03 and 5.1 vs. 2.9 months, p = 0.035, respectively). TMZ also improved PFS2 and OS2 vs. all other systemic therapies (6.6 vs. 4, p < 0.001 and 17 vs. 10 months, p = 0.1). In a subgroup analysis for patients with methylation of the MGMT promoter, doses of >36 Gy as well as TMZ vs. no systemic therapy improved PFS2 (p = 0.045 and p = 0.03, respectively). 27.5% of all patients had no acute toxicity. Three patients with acute and four patients with late grade 3 toxicities were reported.CONCLUSION: Normofractionated radiotherapy is a feasible option for rGBM with a good toxicity profile. Simultaneously applied systemic therapy was associated with improved outcome. For MGMT promoter-methylated histology, higher radiation doses improved survival.
KW - Adult
KW - Aged
KW - Antineoplastic Agents/therapeutic use
KW - Brain Neoplasms/mortality
KW - Combined Modality Therapy
KW - Feasibility Studies
KW - Female
KW - Glioblastoma/mortality
KW - Humans
KW - Male
KW - Middle Aged
KW - Neoplasm Recurrence, Local/mortality
KW - Progression-Free Survival
KW - Radiation Injuries/etiology
KW - Radiotherapy Dosage
KW - Re-Irradiation/adverse effects
KW - Retrospective Studies
KW - Survival Rate
U2 - 10.1007/s00066-020-01585-0
DO - 10.1007/s00066-020-01585-0
M3 - SCORING: Journal article
C2 - 32016497
VL - 196
SP - 457
EP - 464
JO - STRAHLENTHER ONKOL
JF - STRAHLENTHER ONKOL
SN - 0179-7158
IS - 5
ER -