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
. 2021 Jul;23(7):1358-1367.
doi: 10.1007/s12094-020-02526-0. Epub 2021 Feb 2.

High-dose salvage re-irradiation for recurrent/progressive adult diffuse glioma: healing or hurting?

T Gupta  1 , M Maitre  2 , P Maitre  2 , J S Goda  2 , R Krishnatry  2 , A Chatterjee  2 , A Moiyadi  3 , P Shetty  3 , S Epari  4 , A Sahay  4 , V Patil  5 , R Jalali  2
Affiliations

High-dose salvage re-irradiation for recurrent/progressive adult diffuse glioma: healing or hurting?

T Gupta et al. Clin Transl Oncol. 2021 Jul.

Abstract

Purpose: To report survival outcomes and identify prognostic factors of salvage re-irradiation (re-RT) in recurrent/progressive glioma.

Methods: Medical records of patients treated with high-dose re-RT as part of multi-modality salvage therapy for recurrence/progression of adult diffuse glioma from 2010 to 2019 were analyzed retrospectively.

Results: A total of 111 patients developing recurrent/progressive high-grade glioma after adequate upfront treatment at initial diagnosis were included. The first course of radiotherapy (RT) had been delivered to a median dose of 59.4 Gy with an inter-quartile range (IQR) of 54-60 Gy. Median time to recurrence/progression was 4.3 years (IQR = 2.3-7.4 years) while the median time to re-RT was 4.8 years (IQR = 3.6-7.9 years). Re-RT was delivered with intensity-modulated radiation therapy (IMRT) using 1.8 Gy/fraction to a median dose of 54 Gy (IQR = 50.4-55.8 Gy) for a cumulative median equivalent dose in 2-Gy fractions (EQD2) of 104.3 Gy (IQR = 102.6-109.4 Gy). At a median follow-up of 14 months after re-RT, the 1-year Kaplan-Meier estimates of post-re-RT progression-free survival (PFS) and overall survival (OS) were 42.8 and 61.8%, respectively. Univariate analysis identified histological grade at recurrence/progression; histological subtype; disease-free interval (DFI) and time interval between both courses of RT; performance status at re-RT; dose at re-RT and cumulative EQD2; isocitrate dehydrogenase (IDH) mutation; and O6-methyl-guanine DNA methyl transferase (MGMT) gene promoter methylation as significant prognostic factors. Preserved performance status, longer DFI, prolonged time interval between both courses of RT, and presence of IDH mutation were associated with significantly improved PFS on multi-variate analysis. However, only performance status retained independent prognostic significance for OS on multi-variate analysis. Post-treatment changes were seen in 33 (30%) patients on follow-up imaging, with higher cumulative dose (EQD2 ≥ 104.3 Gy) being associated with increased risk of post-re-RT pseudo-progression.

Conclusion: This clinical audit reports encouraging survival outcomes and identifies key prognostic factors associated with high-dose salvage re-RT in recurrent/progressive glioma.

Keywords: Glioma; Prognostic; Re-irradiation; Recurrence; Salvage; Survival.

PubMed Disclaimer

References

    1. Ostrom QT, Cioffi G, Gittleman H, Patil N, Waite K, Kruchko C, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2012–2016. Neuro Oncol. 2019;21:v1-100. https://doi.org/10.1093/neuonc/noz150 . - DOI - PubMed - PMC
    1. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114:97–109. https://doi.org/10.1007/s00401-007-0243-4 . - DOI - PubMed - PMC
    1. Berrocal A, Gil M, Gallego O, Balana C, Segura PP, Garcia-Mata J, et al. SEOM guideline for the treatment of malignant glioma. Clin Transl Oncol. 2012;14:545–50. https://doi.org/10.1007/s12094-012-0839-6 . - DOI - PubMed
    1. Stupp R, Brada M, van den Bent MJ, Tonn JC, Pentheroudakis G. High-grade glioma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25:93–101. https://doi.org/10.1093/annonc/mdu050 . - DOI
    1. Kirkpatrick JP, Sampson JH. Recurrent Malignant Gliomas. Semin Radiat Oncol. 2014;24:289–98. https://doi.org/10.1016/j.semradonc.2014.06.006 . - DOI - PubMed - PMC

MeSH terms

LinkOut - more resources