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. 2019 Sep;6(5):364-374.
doi: 10.1093/nop/npz017. Epub 2019 Apr 12.

Reirradiation of recurrent high-grade glioma and development of prognostic scores for progression and survival

Christopher H Chapman  1 , Jared H Hara  2 , Annette M Molinaro  3   4 , Jennifer L Clarke  3   5 , Nancy Ann Oberheim Bush  3   5 , Jennie W Taylor  3   5 , Nicholas A Butowski  3 , Susan M Chang  3 , Shannon E Fogh  1 , Penny K Sneed  1 , Jean L Nakamura  5 , David R Raleigh  1 , Steve E Braunstein  1
Affiliations

Reirradiation of recurrent high-grade glioma and development of prognostic scores for progression and survival

Christopher H Chapman et al. Neurooncol Pract. 2019 Sep.

Abstract

Background: Optimal techniques and patient selection for salvage reirradiation of high-grade glioma (HGG) are unclear. In this study, we identify prognostic factors for freedom from progression (FFP) and overall survival (OS) after reirradiation, risk factors for high-grade toxicity, and validate clinical prognostic scores.

Methods: A total of 116 patients evaluated between 2000 and 2018 received reirradiation for HGG (99 WHO grade IV, 17 WHO grade III). Median time to first progression after initial therapy was 10.6 months. Salvage therapies before reirradiation included surgery (31%) and systemic therapy (41%). Sixty-five patients (56%) received single-fraction stereotactic radiosurgery (SRS) as reirradiation. The median biologically effective dose (BED) was 47.25 Gy, and the median planning target volume (PTV) was 4.8 cc for SRS and 95.0 cc for non-SRS treatments. Systemic therapy was given concurrently to 52% and adjuvantly to 74% of patients.

Results: Median FFP was 4.9 months, and median OS was 11.0 months. Significant multivariable prognostic factors for FFP were performance status, time to initial progression, and BED; for OS they were age, time to initial progression, and PTV volume at recurrence. High-grade toxicity was correlated to PTV size at recurrence. Three-level prognostic scores were generated for FFP and OS, with cross-validated receiver operating characteristic area under the curve (AUC) of 0.640 and 0.687, respectively.

Conclusions: Clinical variables at the time of reirradiation for HGG can be used to prognosticate FFP and OS.

Keywords: glioblastoma; glioma; prognosis; recurrence; reirradiation.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier curves for freedom from progression and overall survival for all patients. Shaded bands are 95% confidence intervals.
Fig. 2
Fig. 2
Outcomes by prognostic score classes. Timeline is in months from reirradiation. Numbers below timeline represent number at risk. Forest plots are log-rank hazard ratios and P values by prognostic score class. UCSF indicates University of California San Francisco.
See this image and copyright information in PMC

References

    1. Ostrom QT, Gittleman H, Liao P, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2010-2014. Neuro Oncol. 2017;19(suppl 5):v1–v88. - PMC - PubMed
    1. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987–996. - PubMed
    1. Cairncross G, Wang M, Shaw E, et al. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol. 2013;31(3):337–343. - PMC - PubMed
    1. van den Bent MJ, Baumert B, Erridge SC, et al. Interim results from the CATNON trial (EORTC study 26053-22054) of treatment with concurrent and adjuvant temozolomide for 1p/19q non-co-deleted anaplastic glioma: a phase 3, randomised, open-label intergroup study. Lancet. 2017;390(10103):1645–1653. - PMC - PubMed
    1. Niyazi M, Siefert A, Schwarz SB, et al. Therapeutic options for recurrent malignant glioma. Radiother Oncol. 2011;98(1):1–14. - PubMed