Validation of the prognostic Heidelberg re-irradiation score in an independent mono-institutional patient cohort

Radiation Oncology

Claus Belka¹  Stephanie E Combs²  Ute Ganswindt¹  Maya Flieger¹  Maximilian Niyazi¹ 

[1] Department of Radiation Oncology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany;Department of Radiation Oncology, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675 Munich, Germany

关键词: Prognostic;    Heidelberg score;    Glioblastoma;    Glioma;    Radiotherapy;    Re-irradiation;    Bevacizumab;   

Others  :  801386
DOI  :  10.1186/1748-717X-9-128

 received in 2014-03-17, accepted in 2014-03-30,  发布年份 2014

【 摘 要 】

Purpose

Re-irradiation has been shown to be a valid option with proven efficacy for recurrent high-grade glioma patients. Overall, up to now it is unclear which patients might be optimal candidates for a second course of irradiation. A recently reported prognostic score developed by Combs et al. may guide treatment decisions and thus, our mono-institutional cohort served as validation set to test its relevance for clinical practice.

Patients and methods

The prognostic score is built upon histology, age (< 50 vs. ≥ 50 years) and the time between initial radiotherapy and re-irradiation (≤ 12 vs. > 12 months). This score was initially introduced to distinguish patients with excellent (0 points), good (1 point), moderate (2 points) and poor (3–4 points) post-recurrence survival (PRS) after re-irradiation. Median prescribed radiation dose during re-treatment of recurrent malignant glioma was 36 Gy in 2 Gy single fractions. A substantial part of the patients was additionally treated with bevacizumab (10 mg/kg intravenously at d1 and d15 during re-irradiation).

Results

88 patients (initially 61 WHO IV, 20 WHO III, 7 WHO II) re-irradiated in a single institution were retrospectively analyzed. Median follow-up was 30 months and median PRS of the entire patient cohort 7 months. Seventy-one patients (80.7%) received bevacizumab. PRS was significantly increased in patients receiving bevacizumab (8 vs. 6 months, p = 0.027, log-rank test). KPS, age, MGMT methylation status, sex, WHO grade and the Heidelberg score showed no statistically significant influence on neither PR-PFS nor PRS.

Conclusion

In our cohort which was mainly treated with bevacizumab the usefulness of the Heidelberg score could not be confirmed probably due to treatment heterogeneity; it can be speculated that larger multicentric data collections are needed to derive a more reliable score.

【 授权许可】

   
2014 Niyazi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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