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Adjuvant re-irradiation vs. no early re-irradiation of resected recurrent glioblastoma: pooled comparative cohort analysis from two tertiary centers.
Straube, Christoph; Combs, Stephanie E; Bernhardt, Denise; Gempt, Jens; Meyer, Bernhard; Zimmer, Claus; Schmidt-Graf, Friederike; Vajkoczy, Peter; Grün, Arne; Ehret, Felix; Zips, Daniel; Kaul, David.
Affiliation
  • Straube C; Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. christoph.straube@klinikum-landshut.de.
  • Combs SE; Department of Radiation Oncology and Radiotherapy, Klinikum Landshut, Landshut, Germany. christoph.straube@klinikum-landshut.de.
  • Bernhardt D; Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
  • Gempt J; Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
  • Meyer B; Department of Neurosurgery, University Hamburg-Eppendorf, Hamburg, Germany.
  • Zimmer C; Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
  • Schmidt-Graf F; Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
  • Vajkoczy P; Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
  • Grün A; Department of Neurosurgery, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
  • Ehret F; Department of Radiation Oncology, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
  • Zips D; Department of Radiation Oncology, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
  • Kaul D; Charité- Universitätsmedizin Berlin, Berlin, Germany.
J Neurooncol ; 168(1): 49-56, 2024 May.
Article in En | MEDLINE | ID: mdl-38520571
ABSTRACT

BACKGROUND:

The optimal management strategy for recurrent glioblastoma (rGBM) remains uncertain, and the impact of re-irradiation (Re-RT) on overall survival (OS) is still a matter of debate. This study included patients who achieved gross total resection (GTR) after a second surgery after recurrence, following the GlioCave criteria.

METHODS:

Inclusion criteria include being 18 years or older, having histologically confirmed locally recurrent IDHwt or IDH unknown GBM, achieving MRI-proven GTR after the second surgery, having a Karnofsky performance status of at least 60% after the second surgery, having a minimum interval of 6 months between the first radiotherapy and the second surgery, and a maximum of 8 weeks from second surgery to the start of Re-RT.

RESULTS:

A total of 44 patients have met the inclusion criteria. The median OS after the second surgery was 14 months. All patients underwent standard treatment after initial diagnosis, including maximum safe resection, adjuvant radiochemotherapy and adjuvant chemotherapy. Re-RT did not significantly impact OS. However, MGMT promoter methylation status and a longer interval (> 12 months) between treatments were associated with better OS. Multivariate analysis revealed the MGMT status as the only significant predictor of OS.

CONCLUSION:

Factors such as MGMT promoter methylation status and treatment interval play crucial roles in determining patient outcomes after second surgery. Personalized treatment strategies should consider these factors to optimize the management of rGBM. Prospective research is needed to define the value of re-RT after second surgery and to inform decision making in this situation.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Brain Neoplasms / Glioblastoma / Re-Irradiation / Neoplasm Recurrence, Local Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: En Journal: J Neurooncol Year: 2024 Document type: Article Affiliation country:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Brain Neoplasms / Glioblastoma / Re-Irradiation / Neoplasm Recurrence, Local Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: En Journal: J Neurooncol Year: 2024 Document type: Article Affiliation country: