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©The Author(s) 2021.
World J Clin Oncol. Sep 24, 2021; 12(9): 767-786
Published online Sep 24, 2021. doi: 10.5306/wjco.v12.i9.767
Published online Sep 24, 2021. doi: 10.5306/wjco.v12.i9.767
Table 1 Summary of selected publications reporting radiosurgery as salvage treatment in recurrent high-grade gliomas
Ref. | Study type | No. patients | Histology | Re-irradiation | Median interval | Median tumor volume | Median PFS2 | Median OS2 | Severe toxicity | Radionecrosis | |
Total dose, median | Dose/fr, median | ||||||||||
Combs et al[28], 2005 | R | 32 | All GBM | 15 Gy | 63.8 Gy | 10 mo | 10 mL | 7 mo | 10 mo | 0% | 0% |
Hsieh et al[104], 2005 | R | 26 | All GBM | 12 Gy | 42 Gy | NR | 21.6 mL | NR | 10 mo | NR | 31.3% by image |
Kong et al[34], 2008 | P | 114 | 65 GBM, 49 G3G | 16 Gy | 72 Gy | NR | 10.6 mL | 4.6 mo (GBM), 8.6 mo (G3G) | 13 mo (GBM), 26 mo (G3G) | 0% | 24.4% by image |
Patel et al[68], 2009 | R | 26 | All GBM | 18 Gy | 90 Gy | 12.5 mo | 10.4 mL | NR | 8.4 mo | Limited toxicity | NR |
Skeie et al[30], 2012 | R | 51 | All GBM | 12.2 Gy | 43.3 Gy | 11 mo | 12.4 mL | 6 mo | 12 mo | 0% | 0% |
Martínez-Carrillo et al[31], 2014 | R | 87 | 46 GBM, 41 G3G | 18 Gy | 90 Gy | 13.8 mo | 8.7 mL | NR | 7.5 mo (GBM); 17 mo (G3G) | 0% | 0% |
Kim et al[105], 2015 | R | 29 | All GBM | 15 Gy | 63.8 Gy | 8.8 mo | 11 mL | 3.6 mo | 9.2 mo | NR | NR |
Table 2 Summary of selected publications reporting hypofractionated stereotactic radiosurgery as salvage treatment in recurrent gliomas
Ref. | Study type | No. patients | Histology | Re-irradiation | Median interval | Median tumor volume | Median PFS2/actuarial PFS2 | Median OS2 | Severe toxicity | Radionecrosis | ||
Total dose, median | Dose/fr, median | EQD2 | ||||||||||
Selch et al[106], 2000 | R | 21 | 15 GBM, 3 G3G, 2 G2G, 1 no biopsy | 25 Gy | 5 Gy | 43.8 Gy | 11 mo | 12 mL | 5 mo | 6.7 mo | 0% | 0% |
Vordermark et al[107], 2005 | R | 19 | 9 GBM, 10 G2G | 30 Gy | 5 Gy | 52.5 Gy | 19 mo | 15 mL | 4.9 mo, 4.6 mo (GBM) | 9.3 mo, 7.9 mo (GBM) | 10.5% other than necrosis | 0% |
Ernst-stecken et al[108], 2007 | P | 15 | 10 GBM, 3 G3G. 2 G2G | 35 Gy | 7 Gy | 78.7 Gy | 10 mo | 22.4 mL | 15 mo | 12 mo | 20% need to increase steroids dose without evidence of progressive disease | NR |
Fokas et al[78], 2009 | P | 53 | All GBM | 30 Gy | 3 Gy | 37.5 Gy | NR | 35 mL | 22% at 12 mo | 9 mo | 0% | 0% |
Fogh et al[29], 2010 | R | 147 | 105 GBM, 42 G3G | 35 Gy | 3.5 Gy | 48.1 Gy | 8 mo | 22 mL | NR | 11 mo (GBM) | 0.7% toxicity (severe headaches) | 0% |
Mckenzie et al[69], 2013 | P | 33 | 29 GBM, 4 G3G | 30 Gy | 5 Gy | 52.5 Gy | NR | 8.54 mL | 62% at 6 mo | 8.6 mo | 9% toxicity other than necrosis | 9% by image |
Ogura et al[80], 2013 | R | 30 | 15 GBM, 9 G3G. 6 G2G | 35 Gy | 7 Gy | 78.7 Gy | NR | 9 mL | 3 mo | 10.2 mo | 13.3% need to increase steroids dose without evidence of progressive disease | 6.1% by image |
Miwa et al[109], 2014 | P | 21 | All GBM | 30 Gy | 5 Gy | 52.5 Gy | 12 mo | 27.4 mL | NR | 11 mo | 4.8% | 9.5% |
Dincoglan et al[110], 2015 | R | 28 | All GBM | 25 Gy | 5 Gy | 43.8 Gy | 11.2 mo | 36.5 mL | 5.8 mo | 10.3 mo | 0% | 11% G2 by image |
Table 3 Summary of selected publications reporting re-irradiation plus temozolomide as salvage treatment in recurrent high-grade gliomas
Ref. | Study type | No. patients | Histology | Re-irradiation | Median interval | Median tumor volume | Median PFS2/actuarial PFS2 | Median OS2/actuarial OS2 | Severe toxicity | Radionecrosis | ||
Total dose, median | Dose/fr, median | EQD2 | ||||||||||
Grosu et al[49], 2005 | P | 44 (TMZ 29) | 34 GBM, 2 Gliosarcomas, 8 G3G | 30 Gy | 5 Gy | 52.5 Gy | 16 mo | 15 mL | NR | 8 mo (11 mo RT + TMZ vs 6 mo without TMZ) | 0% | 0% |
Combs et al[81], 2008 | R | 25 | 8 GBM, 10 G3G, 7 G2G | 36 Gy | 2 Gy | 36 Gy | 36 mo | 50 mL | 5 mo; 16% at 12 mo | 8 mo; 25% at 12 mo | 0% | NR |
Minniti et al[45], 2011 | R | 36 | All GBM | 37.5 Gy | 2.5 Gy | 42.2 Gy | 14 mo | 13.1 mL | 5 mo; 8% at 12 mo | 9.7 mo; 33% at 12 mo | Thrombocytopenia G3: 2.8% | 8% by image |
Conti et al[47], 2012 | R | 23 (TMZ 12) | All GBM | 20 Gy | 10 Gy | 60 Gy | 7 mo | < 30 mL | 7 mo (TMZ) vs 4 mo (no TMZ) | 12 mo (TMZ) vs 7 mo (without TMZ) | ≥ G3 hematological toxicity > 40% | 4.3% |
Minniti et al[46], 2013 | R | 54 | 38 GBM, 16 G3G | 30 Gy | 6 Gy | 60 Gy | 15.5 mo | 9.8 mL | 6 mo (4 mo GBM) | 12.4 mo (11.4 mo GBM) | Thrombocytopenia G3: 3.7%, leukopenia G3: 3.7% | 7% by image |
Greenspoon et al[111], 2014 | P | 31 | All GBM | 30 Gy | 5 Gy | 52.5 Gy | At least 6 mo | 12 mL | 7 mo | 9 mo | NR | G3: 9.6%, G4: 3.2% |
Aktan et al[48], 2015 | R | 21 (17 TMZ) | 18 GBM, 3 G3G | 54 Gy | 2 Gy | 54 Gy | 39.4 mo | Recurrent tumor size was median 5.5 cm | NR | 18 mo (G3G) and 14.1 mo (GBM) | 0% | 0% |
Table 4 Summary of selected publications reporting re-irradiation plus bevacizumab as salvage treatment in recurrent high-grade gliomas
Ref. | Study type | No. patients | Histology | Re-irradiation | Median interval | Median tumor volume | Median PFS2 | Median OS2 | Severe toxicity | Radionecrosis | ||
Total dose, median | Dose/fr, median | EQD2 | ||||||||||
Gutin et al[56], 2009 | P | 25 | 20 GBM, 5 G3G | 30 Gy | 6 Gy | 60 Gy | 14.5 mo | 34 mL | 7.3 mo | 12.5 mo | G3: 1 hemorrhage; G4: 3 (1 bowel perforation, 1 wound dehiscence and 1 GI bleed) | 0% |
Cuneo et al[54], 2012 | R | 63 (41 BEV) | 49 GBM, 8 G3G, 6 prior G2G | 15 Gy | 15 Gy | 63.8 Gy | 21 mo | 4.8 mL | GBM: 5.2 mo (BEV) vs 2.1 mo (without BEV). 6 mo whole series | GBM: 11.2 mo (BEV) vs 3.9 mo (without BEV). 10 mo whole series | 11% | 10% |
Niyazi et al[52], 2012 | R | 30 (20 BEV) | 22 GBM, 8 G3G | 36 Gy | 2 Gy | 36 Gy | NR | NR | 8 mo | Mean 12 mo | G3:1; G4: 1 wound dehiscence | 0% |
Shapiro et al[112], 2013 | R | 24 | 20 GBM, 1 G3G, 3 G2G | 30 Gy | 6 Gy | 60 Gy | 12.6 mo | 35.3 mL | 7.5 mo (6.8 mo GBM) | 12.2 mo (whole series and GBM) | Toxicity BEV: G4: 12.5% | 0% |
Cabrera et al[113], 2013 | P | 15 | 8 GBM, 7 G3G | 18 Gy. | 18 Gy. | 90 Gy. | 20 mo | NR (< 5 cm) | 3.9 mo | 14.4 mo | G3:1 | 0% |
Flieger et al[57], 2014 | P | 71 (57 BEV) | 52 GBM, 19 G3G and G2G | 36 Gy | 2 Gy | 36 Gy | NR | NR | 5.6 mo (BEV) vs 2.5 mo (without BEV) | GBM: 9.3 mo (BEV) vs 6.1 mo (without BEV) | Toxicity BEV: G4: 5.3% | 4.2% (BEV) by image or histologically |
Table 5 Scoring scheme and new prognostic groups of the “New Combs Score”
Prognostic factors | Prognostic value |
Primary histology | |
Glioblastoma, WHO IV | 2 |
Anaplastic glioma, WHO III | 1 |
Low-grade glioma, WHO I/II | 0 |
Age | |
≥ 50 yr | 1 |
< 50 yr | 0 |
Time between primary RT and re-RT | |
≤ 12 meses | 1 |
> 12 meses | 0 |
Re-resection performed | |
No | 1 |
Yes | 0 |
KPS | |
< 80% | 1 |
≥ 80% | 0 |
Tumor volume (PTV) | |
> 47 mL | 1 |
≤ 47 mL | 0 |
Scoring group | Scoring value/mOS |
a | 0–1/19.5 mo |
b | 2–3/11.3 mo |
c | 4–5/8.1 mo |
d | 6–7/5.5 mo |
- Citation: García-Cabezas S, Rivin del Campo E, Solivera-Vela J, Palacios-Eito A. Re-irradiation for high-grade gliomas: Has anything changed? World J Clin Oncol 2021; 12(9): 767-786
- URL: https://www.wjgnet.com/2218-4333/full/v12/i9/767.htm
- DOI: https://dx.doi.org/10.5306/wjco.v12.i9.767