Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan 28:12:633-639.
doi: 10.2147/CMAR.S217824. eCollection 2020.

Carbon Ion Beam Reirradiation in Recurrent High-Grade Glioma

Fabian Eberle  1   2   3   4 , Stefan Lautenschläger  4 , Rita Engenhart-Cabillic  1   3   4 , Alexandra D Jensen  5 , Barbara Carl  6 , Marco Stein  7 , Jürgen Debus  1   2   3   8   9   10   11 , Henrik Hauswald  1   2   3   4   8   10   11
Affiliations

Carbon Ion Beam Reirradiation in Recurrent High-Grade Glioma

Fabian Eberle et al. Cancer Manag Res. .

Abstract

Background: Patients with recurrent glioma after prior radiotherapy have a poor prognosis. Carbon ion beam radiotherapy offers highly conformal dose distributions and more complex biological radiation effects eventually resulting in optimized normal tissue sparing and improved outcome. The aim of this study was to analyze toxicity, local control and overall survival after reirradiation of recurrent high-grade glioma with carbon ion radiotherapy.

Methods: Between 10/2015 and 12/2018, 30 patients (median age: 59 years) with recurrent high-grade glioma were reirradiated with carbon ion beams and retrospectively analyzed. Diagnosis of recurrent glioma was based on magnetic resonance imaging. Thirteen patients had repeated resection prior to reirradiation and 24 patients underwent additional chemotherapy. The median initial radiation dose was 60 Gy and the median time interval between the initial and repeated radiotherapy was 10 months. The reirradiation dose was 45 Gy (relative biological effectiveness) applied in 15 fractions. All patients received regular follow-up imaging after reirradiation. Kaplan-Meier estimation, log rank test and Cox regression analysis were used for statistical assessment.

Results: Applying common toxicity criteria, there were no grade 5 or 4 adverse events, while 8 patients showed grade 3 adverse events. The median follow-up after reirradiation was 11 months and the median overall survival after diagnosis of recurrent high-grade glioma was 13 months. The 6-, 12- and 24-month overall survival rates after diagnosis of recurrent high-grade glioma were 76%, 50% and 19%, respectively. Upon multivariate Cox regression analysis, a Ki67 score of the initial tumor histology of less than 20% was prognostic. Repeated resection or chemotherapy for the recurrent disease did not result in significantly prolonged survival.

Conclusion: Carbon ion reirradiation in recurrent high-grade glioma is safe and feasible. No radiation-associated grade 4 toxicities were documented and treatment was tolerated well.

Keywords: C12; carbon ion beam therapy; glioblastoma; glioma; particle beam therapy; radiotherapy; reirradiation.

PubMed Disclaimer

Conflict of interest statement

Barbara Carl reports personal fees from Brainlab and B. Braun, outside the submitted work. Jürgen Debus reports grants from Viewray Inc, CRI The Clinical Research Institute GmbH, Accuracy International Sarl, RaySearch Laboratories AB, Vision RT Limited, Merck Serono GmbH, Astellas Pharma GmbH, Astra Zeneca GmbH, Siemens Healthcare GmbH, Solution Akademie GmbH, Ergomed PLC Surrey Research Park, Quintiles GmbH, Pharmaceutical Research Associates GmbH, Boehringer Ingelheim Pharma GmbH&CoKG, PTW Freiburg Dr. Pychlau GmbH, and Nanobiotix S.A., outside the submitted work. All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan-Meier estimation of overall survival after diagnosis of recurrent disease in 30 patients with recurrent high-grade glioma reirradiated with carbon ion beams.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Robert-Koch-Institut. Krebs in Deutschland 2011/2012. Gesundheitsberichterstattung des Bundes. 10;2015. doi:10.17886/rkipubl-2015-004 - DOI
    1. Stupp R, Brada M, van den Bent MJ, Tonn J-C, Pentheroudakis G, ESMO Guidelines Working Group. High-grade glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol off J Eur Soc Med Oncol. 2014;25(Suppl 3):iii93–iii101. doi:10.1093/annonc/mdu050 - DOI - PubMed
    1. Combs SE, Niyazi M, Adeberg S, et al. Re-irradiation of recurrent gliomas: pooled analysis and validation of an established prognostic score-report of the Radiation Oncology Group (ROG) of the German Cancer Consortium (DKTK). Cancer Med. 2018;7(5):1742–1749. doi:10.1002/cam4.1425 - DOI - PMC - PubMed
    1. Krauze AV, Peters C, Cheng J, et al. Re-irradiation for recurrent glioma- the NCI experience in tumor control, OAR toxicity and proposal of a novel prognostic scoring system. Radiat Oncol Lond Engl. 2017;12(1):191. doi:10.1186/s13014-017-0930-9 - DOI - PMC - PubMed
    1. Arvold ND, Shi DD, Aizer AA, et al. Salvage re-irradiation for recurrent high-grade glioma and comparison to bevacizumab alone. J Neurooncol. 2017;135(3):581–591. doi:10.1007/s11060-017-2611-9 - DOI - PubMed