Abstract
PurposesFirst, to evaluate outcome, the benefit of concurrent chemotherapy and prognostic factors in a cohort of sixty-four high-grade glioma patients who underwent a second course of radiation therapy at progression. Second, to validate a new prognostic score for overall survival after reirradiation of progressive gliomas with an independent patient cohort.Patients and methodsAll patients underwent fractionated reirradiation with a median physical dose of 36 Gy. Median planned target volume was 110.4 ml. Thirty-six patients received concurrent chemotherapy consisting in 24/36 cases (67%) of carboplatin and etoposide and in 12/36 cases (33%) of temozolomide. We used the Kaplan Meier method, log rank test and proportional hazards regression analysis for statistical assessment.ResultsMedian overall survival from the start of reirradiation was 7.7 ± 0.7 months. Overall survival rates at 6 and 12 months were 60 ± 6% and 24 ± 6%, respectively. Despite relatively large target volumes we did not observe any major acute toxicity. Concurrent chemotherapy did not appear to improve outcome. In contrast, female gender, young age, WHO grade III histology, favorable Karnofsky performance score and complete resection of the tumor prior to reirradiation were identified as positive prognostic factors for overall survival. We finally validated a recent suggestion for a prognostic score with our independent but small patient cohort. Our preliminary findings suggest that its ability to discriminate between different prognostic groups is limited.ConclusionsOutcome of our patients was comparable to previous studies. Even in case of large target volumes reirradiation seems to be feasible without observing major toxicity. The benefit of concurrent chemotherapy is still elusive. A reassessment of the prognostic score, tested in this study, using a larger patient cohort is needed.
Highlights
Salvage treatment of progressive high-grade gliomas (HGG) remains one of the most challenging tasks in neuro-oncology [1,2]
Female gender, young age, WHO grade III histology, favorable Karnofsky performance score and complete resection of the tumor prior to reirradiation were identified as positive prognostic factors for overall survival
We validated a recent suggestion for a prognostic score with our independent but small patient cohort
Summary
Salvage treatment of progressive high-grade gliomas (HGG) remains one of the most challenging tasks in neuro-oncology [1,2]. Reirradiation has been widely accepted as useful therapeutic option and adopted in clinical routine [3] The credit for this belongs to numerous retrospective studies, which reported satisfactory survival rates and acceptable toxicity in the last two decades. The question which patients would be the best candidates for reirradiation was addressed [12] This question should be subdivided into two aspects: First, in which patients reirradiation is feasible with acceptable toxicity and second, which patients benefit most from reirradiation in terms of survival? A cohort of reirradiated patients has to be compared with a non-irradiated control group In this context, we eagerly await the results of the Radiation Therapy Oncology Group (RTOG) 1205 randomized phase II trial (concurrent bevacizumab and reirradiation versus bevacizumab alone as treatment for recurrent glioblastoma)
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