Cancer Res Treat.  2016 Jan;48(1):37-44. 10.4143/crt.2014.259.

Hypofractionated Stereotactic Radiation Therapy in Recurrent High-Grade Glioma: A New Challenge

• Navarria P
• Ascolese A
• Tomatis S
• Reggiori G
• Clerici E
• Villa E
• Maggi G
• Bello L
• Pessina F
• Cozzi L
• Scorsetti

• KMID: 2152258
• DOI: http://doi.org/10.4143/crt.2014.259

Abstract

PURPOSE
The aim of this study was to evaluate outcomes of hypofractionated stereotactic radiation therapy (HSRT) in patients re-treated for recurrent high-grade glioma.
MATERIALS AND METHODS
From January 2006 to September 2013, 25 patients were treated. Six patients underwent radiation therapy alone, while 19 underwent combined treatment with surgery and/or chemotherapy. Only patients with Karnofsky Performance Status (KPS) > 70 and time from previous radiotherapy greater than 6 months were re-irradiated. The mean recurrent tumor volume was 35 cm3 (range, 2.46 to 116.7 cm3), and most of the patients (84%) were treated with a total dose of 25 Gy in five fractions (range, 20 to 50 Gy in 5-10 fractions).
RESULTS
The median follow-up was 18 months (range, 4 to 36 months). The progression-free survival (PFS) at 1 and 2 years was 72% and 34% and the overall survival (OS) 76% and 50%, respectively. No severe toxicity was recorded. In univariate and multivariate analysis extent of resection at diagnosis significantly influenced PFS and OS (p < 0.01). Patients with smaller recurren tumor volume treated had better local control and survival. Indeed, the 2-year PFS was 40% (< or = 50 cm3) versus 11% (p=0.1) and the 2-year OS 56% versus 33% (> 50 cm3), respectively (p=0.26).
CONCLUSION
In our experience, HSRT could be a safe and feasible therapeutic option for recurrent high grade glioma even in patients with larger tumors. We believe that a multidisciplinary evaluation is mandatory to assure the best treatment for selected patients. Local treatment should also be considered as part of an integrated approach.

Keyword

Glioma; Radiosurgery; Retreatment

MeSH Terms

Diagnosis
Disease-Free Survival
Drug Therapy
Follow-Up Studies
Glioma*
Humans
Karnofsky Performance Status
Multivariate Analysis
Radiosurgery
Radiotherapy
Retreatment
Tumor Burden

Figure

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  Fig. 1. Three views of the computed tomography scan showing the recurrence site (A-C) and dose distribution from the volumetric modulated arc therapy plan (D-F) for one patient.

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  Fig. 2. Overall survival in high-grade glioma patients.

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  Fig. 3. Progression-free survival in high-grade glioma patients.

Reference

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