Re-irradiation for recurrent glioblastoma multiforme: a critical comparison of different concepts.
Strahlenther Onkol
; 196(5): 457-464, 2020 May.
Article
en En
| MEDLINE
| ID: mdl-32016497
ABSTRACT
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 (30â¯× 2â¯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 0.7-44â¯months). Simultaneous systemic therapy improved PFS2 and OS2 (4.3 vs. 2.0, pâ¯< 0.001 and 12 vs. 4â¯months, pâ¯= 0.13, respectively). Therapy with TMZ or bevacizumab improved PFS2 vs. nitrosureas (6.6 vs. 2.9, pâ¯= 0.03 and 5.1 vs. 2.9 months, pâ¯= 0.035, respectively). TMZ also improved PFS2 and OS2 vs. all other systemic therapies (6.6 vs. 4, pâ¯< 0.001 and 17 vs. 10â¯months, pâ¯= 0.1). In a subgroup analysis for patients with methylation of the MGMT promoter, doses of >36â¯Gy as well as TMZ vs. no systemic therapy improved PFS2 (pâ¯= 0.045 and pâ¯= 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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias Encefálicas
/
Glioblastoma
/
Reirradiación
/
Recurrencia Local de Neoplasia
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Límite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Strahlenther Onkol
Asunto de la revista:
NEOPLASIAS
/
RADIOTERAPIA
Año:
2020
Tipo del documento:
Article
País de afiliación:
Alemania