Brain Tumor Res Treat.  2020 Apr;8(1):29-35. 10.14791/btrt.2020.8.e10.

Re-Irradiation and Its Contribution to Good Prognosisin Recurrent Glioblastoma Patients

• Kim MS
• Lim J
• Shin HS
• Cho KG

• KMID: 2500119
• DOI: http://doi.org/10.14791/btrt.2020.8.e10

Abstract

Background
: Radiation therapy, one of the strongest anti-cancer treatments, is already performed to treat primary glioblastoma; however, the effect of repeated radiation therapy for recurrent tumors has not been fully explored. The aim of this study was to determine the efficacy of re-irradiation in treating recurrent glioblastoma.
Methods
: The study included 36 patients with recurrent glioblastoma treated with repeated radiation therapy between 2002 and 2016. Stereotactic radiosurgery (SRS) and hypo-fractionated stereotactic radiotherapy (HSRT) were performed in these patients.
Results
: Fourteen patients received SRS with a median dose of 25 Gy (range, 20-32 Gy) in 1-5 fractions. Twenty-two patients received HSRT with a median dose of 40 Gy (range, 31.5-52 Gy) in 6-20 fractions. There were six treatment-related grade 3 adverse events. Survival analysis showed that re-irradiation significantly prolonged overall survival (OS) and progression-free survival (PFS). The median OS and one-year OS rate after re-irradiation were 17.2 months and 60.4%, respectively. The median PFS and 6-month PFS rate after re-irradiation were 4.4 months and 41.9%, respectively. Of the 36 patients, three survived without any progression in their condition.
Conclusion
: Re-irradiation for recurrent glioblastoma showed favorable outcomes. Radiation dose and fractionation should be carefully considered to minimize radiation necrosis.

Keyword

Recurrent glioblastoma; Re-irradiation; Stereotactic radiosurgery; Toxicity

Figure

• 

  Fig. 1 Treatment case of re-irradiation therapy. Recurrent tumors were diagnosed in a 56-year-old woman 15 months after the initial operation. The patient underwent an operation and re-irradiation of 24-Gy in four fractions. A: Magnetic resonance imaging (MRI) at initial diagnosis. Left: T1 enhanced MRI, Right: T2 fluid-attenuated inversion recovery MRI. B: MRI after the first operation. C: MRI at recurrence. D: MRI after the second operation. E: Re-irradiation treatment plan. Red: planning target volume; orange: 95% iso-dose line; yellow: 90% iso-dose line; light green: 80% iso-dose line; sky blue: 40% iso-dose line. F: MRI 7 months after re-irradiation

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  Fig. 2 Kaplan-Meier survival analysis. A: Overall survival. B: Progression-free survival.

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  Fig. 3 Overall survival rates following surgical resection.

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