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Hypofractionated Stereotactic Reirradiation of Recurrent Glioblastomas

A Beneficial Treatment Option after High-Dose Radiotherapy?

Ist die hypofraktionierte stereotaktische Reradiatio eine sinnvolle Behandlungsoption rezidivierter Glioblastome nach vorheriger hochdosierter Bestrahlung?

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Background and Purpose:

Recurrent malignant gliomas have a very poor prognosis. This trial aimed to evaluate the benefits of reirradiation in case of recurrent glioblastoma multiforme (GBM) using hypofractionated stereotactic radiotherapy (hFSRT) after primary high-dose percutaneous irradiation.

Patients and Methods:

Between 1998 and 2008, 53 patients with recurrent GBM were treated by hFSRT based on CT and MR imaging. At the time of recurrence, a median total dose of 30 Gy (20–60 Gy) was delivered in median fractions of 3 Gy/day (2–5Gy).

Results:

The reirradiation was well tolerated (no acute or late toxicity > grade 2), despite the relatively large median tumor volume (35.01 ml). Karnofsky Performance Score was the strongest predictor for survival after reirradiation (p = 0.0159). Tumor volume (p = 0.4690), patient age (p = 0.4301), second operation (p = 0.6930), and chemotherapy (p = 0.1466) at the time of reirradiation did not affect survival. After hFSRT, the median survival was 9 months, and the 1-year progression-free survival (PFS) amounted to 22%.The median overall survival from initial diagnosis was 27 months. 1-year survival from first diagnosis was 83%, 2-year survival 45%. The median time to progression from the end of initial irradiation to recurrence was 12 months. 1-year PFS before reirradiation was 40%.

Conclusion:

hFSRT as a secondary treatment of recurrent GBM is a feasible and effective treatment option. Only minor side effects were observed with prolonged life expectancy of 9 months.

Hintergrund und Ziel:

Die Prognose im Rezidivfall eines malignen Glioms ist schlecht. Diese Studie hatte zum Ziel, den Stellenwert einer hypofraktionierten stereotaktischen Rebestrahlung (hFSRT) bei rezidiviertem Glioblastom (GBM) nach perkutaner hochkonformaler Radiotherapie zu evaluieren.

Patienten und Methodik:

Zwischen 1998 und 2008 wurden 53 Patienten mit einem rezidivierten GBM stereotaktisch rebestrahlt. Die mediane Gesamtherddosis betrug 30 Gy (20–60 Gy), die mediane Einzelherddosis 3 Gy/Tag (2–5 Gy).

Ergebnisse:

Trotz großer Tumorvolumen von median 35,01 ml wurde nach hFSRT keine Akut- oder Spättoxizität > Grad 2 beobachtet. Der Karnofsky-Perfomance-Score war der einzige determinante Faktor hinsichtlich des Gesamtüberlebens nach hFSRT (p = 0,0159). Hingegen beeinflussten Tumorvolumen (p = 0,4690), Patientenalter (p = 0,4301), Zweitoperationen (p = 0,6930) oder Chemotherapie (p = 0,1466) das Gesamtüberleben nach hFSRT nicht. Das mediane Gesamtüberleben nach hFSRT betrug 9 Monate, das progressionsfreie 1-Jahres-Überleben (PFS) 22%. Das mediane Gesamtüberleben nach initialer Diagnosestellung eines GBM lag bei 27 Monaten, das 1- bzw. 2-Jahres-Gesamtüberleben bei 83% bzw. 45%. Der mediane Zeitpunkt bis zum ersten Rezidiv nach initialer Bestrahlung betrug 12 Monate, das 1-Jahres-PFS nach initialer Bestrahlung bis zum ersten Rezidiv 40%.

Schlussfolgerung:

Die hFSRT ist eine geeignete und effektive Behandlungsoption für rezidivierte GBM. Das mediane Gesamtüberleben nach hFSRT konnte bei geringer Nebenwirkungsrate um 9 Monate verlängert werden.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Gießen and Marburg, Marburg, Germany

    Emmanouil Fokas MD, Ulrich Wacker, Markus W. Gross, Martin Henzel, Elitsa Encheva & Rita Engenhart-Cabillic

  2. Department of Radiation Oncology, Medical University of Sofia, Sofia, Bulgaria

    Elitsa Encheva

  3. Department of Radiotherapy and Radiation Oncology, University Hospital Gießen and Marburg, Baldingerstraße, 35043, Marburg, Germany

    Emmanouil Fokas MD

Authors
  1. Emmanouil Fokas MD
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  2. Ulrich Wacker
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  3. Markus W. Gross
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  4. Martin Henzel
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  5. Elitsa Encheva
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  6. Rita Engenhart-Cabillic
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Correspondence to Emmanouil Fokas MD.

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Both authors contributed equally to the study.

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Fokas, E., Wacker, U., Gross, M.W. et al. Hypofractionated Stereotactic Reirradiation of Recurrent Glioblastomas. Strahlenther Onkol 185, 235–240 (2009). https://doi.org/10.1007/s00066-009-1753-x

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  • DOI: https://doi.org/10.1007/s00066-009-1753-x

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