Hypofractionated stereotactic radiation therapy for recurrent glioblastoma: single institutional experience

Radiation Oncology

Cinzia Iotti²  Mauro Iori³  Elisabetta Cagni³  Andrea Botti³  Anna Pisanello¹  Nunziata D’Abbiero²  Maria Galeandro²  Ala Podgornii²  Patrizia Ciammella² 

[1] Neurology Unit, Dipartimento Neuro-Motorio, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42123 Reggio Emilia, Italy;Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42123 Reggio Emilia, Italy;Medical Physics Unit,Department of Oncology and Advanced Technology, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42123 Reggio Emilia, Italy

关键词: Acute toxicity;    Re-irradiation;    Stereotactic radiation therapy;    Recurrent glioblastoma;   

Others  :  1152870
DOI  :  10.1186/1748-717X-8-222

 received in 2013-07-09, accepted in 2013-09-17,  发布年份 2013

【 摘 要 】

Background

Glioblastoma (GBM) is the most common malignant primary brain tumor in adults. Tumor control and survival have improved with the use of radiotherapy (RT) plus concomitant and adjuvant chemotherapy, but the prognosis remain poor. In most cases the recurrence occurs within 7–9 months after primary treatment. Currently, many approaches are available for the salvage treatment of patients with recurrent GBM, including resection, re-irradiation or systemic agents, but no standard of care exists.

Methods

We analysed a cohort of patients with recurrent GBM treated with frame-less hypofractionated stereotactic radiation therapy with a total dose of 25 Gy in 5 fractions.

Results

Of 91 consecutive patients with newly diagnosed GBM treated between 2007 and 2012 with conventional adjuvant chemo-radiation therapy, 15 underwent salvage RT at recurrence. The median time interval between primary RT and salvage RT was 10.8 months (range, 6–54 months). Overall, patients undergoing salvage RT showed a longer survival, with a median survival of 33 vs. 9.9 months (p= 0.00149). Median overall survival (OS) from salvage RT was 9.5 months. No patients demonstrated clinically significant acute morbidity, and all patients were able to complete the prescribed radiation therapy without interruption.

Conclusion

Our results suggest that hypofractionated stereotactic radiation therapy is effective and safe in recurrent GBM. However, until prospective randomized trials will confirm these results, the decision for salvage treatment should remain individual and based on a multidisciplinary evaluation of each patient.

【 授权许可】

   
2013 Ciammella et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO: Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005, 352:987-996.
• [2]van den Bent MJ, Brandes AA, Rampling R, et al.: Randomized phase II trial of erlotinib versus temozolomide or carmustine in recurret glioblastoma: EORTC Brain Tumor Group study 26034. J Clin Oncol 2009, 27(8):1268-1274.
• [3]Brandes AA, Tosoni A, Amista P, et al.: How effective is BCNU in recurrent glioblastoma in the modern era? A phase II trial. Neurology 2004, 63(7):1281-1284.
• [4]Reithmeier T, Graf E, Piroth T, Trippel M, Pinsker MO, et al.: BCNU for recurrent glioblastoma multiforme: efficacy, toxicity and prognostic factord. BMC Cancer 2010 Feb 2, 10:30. BioMed Central Full Text
• [5]Batchelor T, Mulholland P, Neyns B, et al.: The efficacy of cediranib as monotherapy and in combination with lomustine compared to lomustine alone in patients with recurrent glioblastoma: a phase III randomized trial. Neuro Oncol 2010, 12(Suppl. 4):75.
• [6]Happold C, Roth P, Wick W, et al.: ACNU-based chemotherapy for recurrent glioma in the temozolomide era. J Neurooncol 2009, 92(1):45-48.
• [7]Addeo R, Caraglia M, De Santi MS, et al.: A new schedule of fotemustine in temozolomide-pretreated patients with relapsing glioblastoma. J Neuroncol 2011, 102(3):417-424.
• [8]Scoccianti S, Detti B, Sardaro A, et al.: Second-line chemotherapy with fotemustine in temozolomide-pretreated patients with relapsing glioblastoma: a single institution experience. Anticancer Drugs 2008, 19(6):613-620.
• [9]Brada M, Hoang-Xuan K, Rampling R, et al.: Randomized phase II trial of temozolomide in patients with glioblastoma multiforme at first relapse. Ann Oncol 2001, 1282:259-266.
• [10]Brandes AA, Ermani M, Basso U, et al.: Temozolomide as a second-line sistemi regimen in recurrent high-grade glioma: a phase II study. Ann Oncol 2011, 12(2):255-257.
• [11]Brandes AA, Ermani M, Basso U, et al.: Temozolomide in patients with glioblastoma at second relapse after first line nitrosurea-procarbazine failure: a phase II study. Oncology 2002, 63(1):38-41.
• [12]Khan RB, Raizer JJ, Malkin MG, et al.: A phase II study of extended low-dose temozolomide in recurrent malignant gliomas. Neuro Oncol 2002, 4(1):39-43.
• [13]Brandes AA, Tosoni A, Cavallo G, et al.: Temozolomide 3 weeks on and 1 week off as first-line therapy for recurrent glioblastoma: phase II study from Gruppo Italiano Cooperativo di Neuro-oncologia (GICNO). Br J Cancer 2006, 95(9):1155-1160.
• [14]Balmaceda C, Peereboom D, Pannullo S, et al.: Multi-institutional phase II study of temozolomide administered twice daily in the treatment of recurrent high-grade gliomas. Cancer 2008, 112(5):1139-1146.
• [15]Wick W, Steinbach JP, Kuker WM, et al.: One week on/one week off: a novel active regimen of temozolomide for recurrent glioblastoma. Neurology 2004, 62(11):2113-2115.
• [16]Yung WK, Albright RE, Olson J, et al.: A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer 2000, 83(5):588-593.
• [17]Franceschi E, Omuro AM, Lassman AB, Demopoulos A, et al.: Salvage temozolomide for prior temozolomide responders. Cancer 2005, 104(11):2473-2476.
• [18]Kong DS, Lee JI, Kim WS, et al.: A pilot study of metronomic temozolomide treatment in patients with recurrent temozolomide-refractory glioblastoma. Oncol Rep 2006, 16(5):117-1121.
• [19]Berrocal A, Perez Segura P, Gil M, et al.: Extended-schedule dose-dense temozolomide in refractory gliomas. J Neuroncol 2010, 96(3):417-422.
• [20]Kong DS, Lee JI, Kim JH, et al.: Phase II trial of low-dose continuous (metronomic) treatment of temozolomide for recurrent glioblastoma. Neuro Oncol 2010, 12(3):289-296.
• [21]Hammond A, Norden AD, Lesser GJ, et al.: Phase II study of dose-intense temozolomide in recurrent gliblastoma. J Clin Oncol 2038, 2011:29.
• [22]Park JK, Hodges T, Arko L, et al.: Scale to predict survival after surgery for recurrent glioblastoma multiforme. J Clin Oncol 2010, 28(24):3838-3843.
• [23]Barbagallo GM, Jenkinson MD, Brodbelt AR: Recurrent Gliobastoma multiforme- when should we reoperate? Br J Neurosurg 2008, 22(3):452-455.
• [24]Dhermain F, de Crevoisier R, Parker F, Cioloca C, Kaliski A, Beaudre A, Lefkopoulos D, Armand JP, Haie-Meder C: Role of radiotherapy in recurrent gliomas. Bull Cancer 2004, 91(11):883-889.
• [25]Coombs SE, Debus J, Shulz-Ertner D: Radiotherapeutic alternatives for previously irradiated recurrent gliomas. BMC Cancer 2007, 7:167. BioMed Central Full Text
• [26]Hall WA, Djalilian HR, Sperduto PW, et al.: Stereotactic radiosurgery for recurrent malignant gliomas. J Clin Oncol 1995, 13:1642-1648.
• [27]Cabrera AR, Cuneo KC, Vredenburgh JJ, et al.: Stereotactic radiosurgery and bevacizumab for recurrent glioblastoma multiforme. J Natl Compr Canc Netw 2012 Jun 1, 10(6):695-699.
• [28]Combs SE, Widmer V, Thilmann C, et al.: Stereotactic radiosurgery (SRS): treatment option for recurrent glioblastoma multiforme (GBM). Cancer 2005, 104:2168-2173.
• [29]Patel M, Siddiqui F, Jin JY, Mikkelsen T, et al.: Salvage reirradiation for recurrent glioblastoma with radiosurgery: radiographic response and improved survival. J Neurooncol 2009, 92:185-191.
• [30]Cho KH, Hall WA, Gerbi BJ, Higgins PD, et al.: Single dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas. Int J Radiat Oncol Biol Phys 1999, 45:1133-1141.
• [31]Combs SE, Gutwein S, Thilman CH, et al.: Stereotactically guided fractionated reirradiation in recurrent glioblastoma multiforme. J Neurooncol 2005, 74:167-171.
• [32]Combs SE, Thilman CH, Edler L, et al.: Efficacy of fractionated stereotactic reiraddiation in recurrent gliomas: long-term result in 172 patients treated in a single institution. J Clin Oncol 2005, 23:8863-8869.
• [33]Vordermark D, Kolbl O, Ruprecht K, et al.: Hypofractionated stereotactic re-irradiarion: treatment option in recurrent malignant glioma. BMC Cancer 2005, 5:55. BioMed Central Full Text
• [34]Lederman G, Wronski M, Arbit E, et al.: Treatment of recurrent glioblastoma multiforme using fractionated stereotactic radiosurgery and concurrent paclitaxel. Am J Clin Oncol 2000, 23:155-159.
• [35]Arcicasa M, Roncadin M, Bidoli E, et al.: Reirradiation and lomustine in patients with relapsed high-grade gliomas. Int J Radiat Oncol Biol Phys 1999, 43:789-793.
• [36]Combs SE, Bischof M, Welzel T, et al.: Radiochemotherapy with temozolomide as re-irradiation using high precision fractionated stereotactic radiotherapy (FSRT) in patients with recurrent gliomas. J Neurooncol 2008, 89:205-210.
• [37]Minniti G, Armosini V, Salvati M, et al.: Fractionated stereotactic reirradiation and concurrent temozolomide in patients with recurrent glioblastoma. J Neurooncol 2011, 103(3):683-691.
• [38]Louis DN, Ohgaki H, Wiestler OD, Cavenee WK: WHO Classification of Tumours of the Central Nervous System. IARC: Lyon; 2007.
• [39]Lee SW, Fraas BA, Marsh LH, et al.: Patterns of failure following hig-dose 3-D conformal radiotherapy for high-grade astrocytomas: A quantitative dosimetric study. Int J Radiat Oncol Biol Phys 1999, 43(199):79-88.
• [40]Ammirati M, Galicich JH, Arbit E, Liao Y: Reoperation in the treatment of recurrent intracranial malignant gliomas. Neurosurgery 1987, 21:607-614.
• [41]Hou LC, Veeravagu A, Hsu AR, Tse VC: Recurrent glioblastoma multiforme: a review of natural history and management options. Neurosurgical focus 2006, 20:E5.
• [42]Nieder C, Grosu AL, Molls M: A comparison of treatment results for recurrent malignant gliomas. Cancer Treat Rev 2000, 26:397-409.
• [43]Stupp R, Hegi ME, Gilbert MR, et al.: Chemoradiotherapy in malignant glioma: standard of care and future directions. J Clin Oncol 2007, 25:4127-4136.
• [44]Brandes AA, Franceschi E, Tosoni A, Bartolini S, Bacci A, Agati R, et al.: O(6)-methylguanine DNA-methyltransferase methyleation status can change between first surgery for newly diagnosed glioblastoma and second surgery from recurrence: clinical implications. Neuro Oncol 2010, 12:283-288.
• [45]Vredenburgh JJ, Desjardinis A, Herndon JE 2nd, et al.: Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol 2007, 25:4722-4729.
• [46]Young B, Oldfield EH, Markesbery WR, Haack D, Tibbs P, McCoombs P, et al.: Reoperation for glioblastoma. J Neurosurg 1981, 55:917-921.
• [47]Barker FG 2nd, Chang SM, Gutin PH, Malec MK, McDermott MW, Prados MD, et al.: Survival and functional status after resection of recurrent glioblastoma multiforme. Neurosurgery 1998, 42:709-720.
• [48]Sirin S, Oysul K, Surenkok S, et al.: Linear accelerator-based stereotactic radiosurgery in recurrent glioblastoma: a single center experience. Vojnosanit Pregl 2011, 68(11):961-6.
• [49]Simon JM, Cornu P, Boisserie G, et al.: Brachytherapy of glioblastoma recurring in previously irradiated territory: predictive value of tumor volume. Int J Radiat Oncol Biol Phys 2002, 53:67-74.
• [50]Chan TA, Weingart JD, Parisi M, et al.: Treatment of recurrent glioblastoma multiforme with GliaSite brachytherapy. Int J Radiat Oncol Biol Phys 2005, 62:1133-1139.
• [51]Larson DA, Prados M, Lamborn KR, et al.: Phase II study of high central dose gamma knife radiosurgery and marimastat in patients with recurrent malignant glioma. Int J Radiat Oncol Biol Phys 2002, 54:1397-1404.
• [52]Shrieve DC, Alexander E 3rd, Wen PY, et al.: Comparison of stereotactic radiosurgery and brachytherapy in the treatment of recurrent glioblastoma multiforme. Neurosurgery 1995, 36:275-282. discussion 282–4
• [53]Grosu AL, Weber WA, Franz M, et al.: Reirradiation of recurrent high-grade gliomas using amino acid PET (SPECT)/CT/MRI image fusion to determine gross tumor volume for stereotactic fractionated radiotherapy. Int J Radiat Oncol Biol Phys 2005, 63:511-519.
• [54]Kohshi K, Yamamoto H, Nakahara A, et al.: Fractionated stereotactic radiotherapy using gamma unit after hyperbaric oxygenation on recurrent high-grade gliomas. J Neurooncol 2007, 82:297-303.
• [55]Ernst-Stecken A, Ganslandt O, Lambrecht U, Sauer R, Grabenbauer G: Survival and quality of life after hypofractionated stereotactic radiotherapy for recurrent malignant glioma. J Neurooncol 2007, 81:287-294.
• [56]Fokas E, Wacker U, Gross MW, Henzel M, Encheva E, Engenhart-Cabillic R: Hypofractionated stereotactic reirradiation of recurrent glioblastomas: a beneficial treatment option after high-dose radiotherapy? Strahlenther Onkol 2009, 185:235-240.
• [57]Henke G, Paulsen F, Steinbach JP, Ganswindt U, Isijanov H, Kortmann RD, Bamberg M, Belka C: Hypofractionated reirradiation for recurrent malignant glioma. Strahlenther Onkol 2009, 185:113-119.
• [58]Fogh SE, Anrews DW, Glass J, Curran W, Glass C, Champ C, Evans JJ, Hyslop T, Pequignot E, Downes B, Comber E, Maltenfort M, Dicker AP, Werner-Wasik M: Hypofractionated stereotactic radiation therapy: an effective therapy for recurrent high-grade gliomas. J Clin Oncol 2010, 28:3048-3053.
• [59]Shepherd SF, Laing RW, Cosgrove VP, Warrington AP, Hines F, Ashley SE, Brada M: Hypofractionated stereotactic radiotherapy in the management of recurrent glioma. Int J Radiat Oncol Biol Phys 1997, 37:393-398.
• [60]Glass J, Silverman CL, Axelrod R, Corn BW, Andrews DW: Fractionated stereotactic radiotherapy with cis-platinum radiosensitization in the treatment of recurrent, progressive or persistent malignant astrocytoma. Am J Clin Oncol 1997, 20:226-229.
• [61]Hudes RS, Corn BW, Werner-Wasik M, Andrews D, Rosenstock J, Thoron L, Downes B, Curran WJ: A phase I dose escalation study of hypofractionated stereotactic radiotherapy as salvage therapy for persistent or recurrent malignant glioma. Int J Radiat Oncol Biol Phys 1999, 43:291-298.
• [62]Voynov G, Kaufman S, Hong T, Pinkerton A, Simon R, Dowsett R: Treatment of recurrent malignant gliomas with stereotactic intensity modulated radiation therapy. Am J Clin Oncol 2002, 25:606-611.
• [63]Veninga T, Langendijk HA, Slotman BJ, et al.: Reirradiation of primary brain tumors: serviva, clinical response and prognostic factors. Rdaiother Oncol 2001, 59:127-137.
• [64]Nieder C, Astner ST, Mehta MP, et al.: Improvement, clinical course, and quality of life after palliative radiotherapy for recurrent glioblastoma. Am J Clin Oncol 2008, 31:300-305.
• [65]Chang EL, Akurek S, Avalos T, et al.: Evaluation of peritumoral edema in the delineation of radiotherapy clinical target volumes for glioblastoma. Int J Radiat Oncol Biol Phys 2007, 86:144-150.
• [66]Liang BC, Thornton AF Jr, Sandler HM, et al.: Malignant atrocytomas: focal tumor recurrence after local external beam radiation therapy. J Neurosurg 1991, 75:559-563.
• [67]Lee SW, Fraass BA, Marsh LH, et al.: Patterns of failure following high-dose 3-D conformal radiotherapy for high-grade astrocytomas: A quantitative dosimetric study. Int J Radiat Oncol Biol Phys 1999, 43:79-88.
• [68]McDonald MW, Shu HK, Curran WJ, et al.: Pattern of failure after limited margin radiotherapy and temozolomide for glioblastoma. Int J Radiat Oncol Biol Phys 2011, 79:130-136.
• [69]Minniti G, Amelio D, Amichetti M, et al.: Patterns of failure and comparison of different target volume delineations in patients with gliobalstoma treated with conformal radiotherapy plus concomitant and adjuvant temozolomide. Rdaiother Oncol 2010, 97:377-381.
• [70]Milano MT, Okunieff P, Donatello RS, et al.: Patterns and timing of recurrence after temozolomide-based chemoradiation for glioblastoma. Int J Radiat Oncol Biol Phys 2010, 78:1147-1155.
• [71]Brandes AA, Tosoni A, Franceschi E, et al.: Recurrence pattern after temozolomide concomitant with and ajuvant to radiotherapy in newly diagnosed patients with glioblastoma: correlation with MGMT promoter methylation status. J Clin Oncol 2009, 27:1275-1279.
• [72]Hochberg FH, Pruitt A: Assumption in the radiotherapy glioblastoma. Neurology 1980, 30:907-911.
• [73]Stewart LA: Chemotherapy in adult high-grade glioma: A systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet 2002, 359:1011-1018.
• [74]Laing RW, Warrington AP, Graham J, et al.: Efficacy and toxicity of fractionated stereotactic radiotherapy in the treatment of recurrent gliomas (Phase I/II study). Radiother Oncol 1993, 27:22-29.