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Review
. 2022 Mar 22;12(4):416.
doi: 10.3390/brainsci12040416.

Relapsing High-Grade Glioma from Peritumoral Zone: Critical Review of Radiotherapy Treatment Options

Maria Chiara Lo Greco  1 , Roberto Milazzotto  2 , Rocco Luca Emanuele Liardo  2 , Grazia Acquaviva  3 , Madalina La Rocca  1 , Roberto Altieri  4   5 , Francesco Certo  4   5 , Giuseppe Maria Barbagallo  4   5 , Antonio Basile  6   7 , Pietro Valerio Foti  6   7 , Stefano Palmucci  6   7 , Stefano Pergolizzi  1 , Antonio Pontoriero  1 , Corrado Spatola  2   5   7
Affiliations
Review

Relapsing High-Grade Glioma from Peritumoral Zone: Critical Review of Radiotherapy Treatment Options

Maria Chiara Lo Greco et al. Brain Sci. .

Abstract

Glioblastoma (GBM) is the most common and aggressive brain tumor in adults, with a median survival of about 15 months. After the prior treatment, GBM tends to relapse within the high dose radiation field, defined as the peritumoral brain zone (PTZ), needing a second treatment. In the present review, the primary role of ionizing radiation in recurrent GBM is discussed, and the current literature knowledge about the different radiation modalities, doses and fractionation options at our disposal is summarized. Therefore, the focus is on the necessity of tailoring the treatment approach to every single patient and using radiomics and PET/MRI imaging to have a relatively good outcome and avoid severe toxicity. The use of charged particle therapy and radiosensitizers to overcome GBM radioresistance is considered, even if further studies are necessary to evaluate the effectiveness in the setting of reirradiation.

Keywords: PET/MRI imaging; altered fractionations; charged particle therapy; glioblastoma; peritumoral zone; proton therapy; radiomics; radiosensitizers; reirradiation; stereotactic radiosurgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Differences in terms of fractionations between stereotactic radiosurgery (SRS), fractionated stereotactic radiotherapy (FSRT) and conventionally fractionated radiotherapy (CFRT).
Figure 2
Figure 2
Example of dose distribution for small lesion treated with stereotactic radiotherapy: the colors correspond to an EQD2a/b = 2 of blue > 8 Gy; green > 30 Gy; yellow > 40 Gy; red > 50 Gy.
Figure 3
Figure 3
Two enhanced lesions (long and short arrow) were demonstrated in the left temporal lobe on T1-weighted magnetic resonance imaging (A), MET-PET demonstrated a MET high-uptake on the region of short arrow (B), only the enhanced lesion (short arrow) was treated with RT; 5 months later it was increased in size (C) but not in uptake (D) (suggestive of pseudoprogression) while the non treated lesion remained stable [58].
See this image and copyright information in PMC

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