Abstract
PurposeTo investigate radiation oncologists’ opinions on important considerations to offering re-irradiation (re-RT) as a treatment option for recurrent glioma.Materials and methodsA survey was conducted with 13 radiation oncologists involved in the care of central nervous system tumor patients. The survey was comprised of 49 questions divided into 2 domains: a demographic section (10 questions) and a case section (5 re-RT cases with 5 to 6 questions representing one or several re-RT treatment dilemmas as may be encountered in the clinic). Respondents were asked to rate the relevance of various factors to offering re-RT, respond to the cases with a decision to offer re-RT vs. not, volume to be treated, margins to be employed, dose/fractionation suggested and any additional comments with respect to rationale in each scenario.ResultsSixty nine percent of responders have been practicing for greater than 10 years and 61% have re-RT 20 to 100 patients to date, with 54% seeing 2–5 re-RT cases per month and retreating 1–2 patients per month. Recurrent tumor volume, time since previous radiation therapy, previously administered dose to organs at risk and patient performance status were rated by the majority of responders (85%, 92%, 77%, and 69% respectively) as extremely relevant or very relevant to offering re-RT as an option.ConclusionThe experts’ practice of re-RT is still heterogeneous, reflecting the paucity of high-quality prospective data available for decision-making. Nevertheless, practicing radiation oncologists can support own decisions by referring to the cases found suitable for re-RT in this survey.
Highlights
Seventy-eight thousand brain tumors are diagnosed in the United States per year with gliomas representing approximately one third [1]
Time since previous radiation therapy, previously administered dose to organs at risk and patient performance status were rated by the majority of responders (85%, 92%, 77%, and 69% respectively) as extremely relevant or very relevant to offering re-Radiation Therapy (RT) as an option
Survey results Thirteen radiation oncology experts, 8 from the United States and 5 from Europe responded to the survey and are included as co-authors on this manuscript
Summary
Seventy-eight thousand brain tumors are diagnosed in the United States per year with gliomas representing approximately one third [1]. All gliomas eventually recur following treatment and in their natural history carry devastating neurological and psychological implications for those affected. Patients with a diagnosis of glioma may undergo multiple resections, radiation therapy and multiple lines of systemic treatment with diminishing treatment options as the disease progresses. Re-irradiation (re-RT) as a possible treatment option often enters the discussion and multiple retrospective studies have shown re-RT to be feasible and to improve. Re-RT is the subject of several ongoing trials, the results thereof, highly relevant and anticipated, are likely to leave us with unanswered questions. Many patients with recurrent glioma who may be considered for re-RT in the clinic would not necessarily have been eligible for the ongoing trials but according to existing data may derive benefit from re-RT and may receive re-RT when no other options are available
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