Yonsei Med J.  2018 Mar;59(2):194-201. 10.3349/ymj.2018.59.2.194.

Hypofractionated Re-irradiation after Maximal Surgical Resection for Recurrent Glioblastoma: Therapeutic Adequacy and Its Prognosticators of Survival

• Lee J
• Ahn SS
• Chang JH
• Suh CO

• KMID: 2418781
• DOI: http://doi.org/10.3349/ymj.2018.59.2.194

Abstract

PURPOSE
To evaluate the adequacy of retreatment, including hypofractionated re-irradiation (HFReRT), after surgery for recurrent glioblastoma (GBM) and related prognosticators of outcomes.
MATERIALS AND METHODS
From 2011 to 2014, 25 consecutive patients with recurrent (n=17) or secondary (n=7) disease underwent maximal surgery and subsequent HFReRT after meeting the following conditions: 1) confirmation of recurrent or secondary GBM after salvage surgery; 2) Karnofsky performance score (KPS) ≥60; and 3) interval of ≥12 months between initial radiotherapy and HFReRT. HFReRT was delivered using a simultaneous integrated boost technique, with total dose of 45 Gy in 15 fractions to the gross tumor volume (GTV) and 37.5 Gy in 15 fractions to the clinical target volume.
RESULTS
During a median follow-up of 13 months, the median progression-free and overall survival (OS) were 13 and 16 months, respectively. A better KPS (p=0.026), no involvement of the eloquent area at recurrence (p=0.030), and a smaller GTV (p=0.005) were associated with better OS. Additionally, OS differed significantly between risk groups stratified by the National Institutes of Health Recurrent GBM Scale (low-risk vs. high-risk, p=0.025). Radiologically suspected radiation necrosis (RN) was observed in 16 patients (64%) at a median of 9 months after HFReRT, and 8 patients developed grade 3 RN requiring hospitalization.
CONCLUSION
HFReRT after maximal surgery prolonged survival in selected patients with recurrent GBM, especially those with small-sized recurrences in non-eloquent areas and good performance.

Keyword

Recurrent glioblastoma; retreatment; re-irradiation; surgery; survival

MeSH Terms

Adult
Brain Neoplasms/mortality/pathology/*therapy
Dose Hypofractionation
Female
Glioblastoma/mortality/pathology/*therapy
Humans
Karnofsky Performance Status
Male
Middle Aged
Neoplasm Recurrence, Local/mortality/pathology/*therapy
Prognosis
*Radiosurgery
Re-Irradiation/*methods
Salvage Therapy/methods
Survival Rate
Treatment Outcome

Figure

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  Fig. 1 Kaplan-Meier curves of PFS and OS. PFS, progression-free survival; OS, overall survival.

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  Fig. 2 OS according to the KPS (A), eloquent area involvement at recurrence (B), GTV (C), and CTx after hypofractionated re-irradiation (D). OS, overall survival; KPS, Karnofsky performance score; GTV, gross tumor volume; CTx, chemotherapy.

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  Fig. 3 OS according to prognostic groups, defined according to the NIH recurrent glioblastoma scale. OS, overall survival; NIH, National Institutes of Health.

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