Concurrent hyperthermia and re-irradiation for recurrent high-grade gliomas

Abstract

Salvage therapy for recurrent high grade gliomas (HGG) includes surgery, radiotherapy and chemotherapy, however, standard treatment does not exist. We evaluated the tolerability and efficacy of re-irradiation (re-RT) with hyperthermia (HT) for patients with recurrent HGG. From September 2010 to July 2015, 20 patients with recurrent HGG were treated with re-RT and HT. The radiotherapy dose of 30 Gray (Gy) was delivered with 2 Gy per fraction daily, and HT was performed twice weekly. Primary endpoints were treatment compliance and toxicity. Second endpoints were overall survival (OS) and progression free survival (PFS). The median interval between initial RT and re-RT was 11 months. During re-RT with HT, there were no significant acute morbidities over grade 3. Median overall survival (OS) from re-irradiation was 8.4 months and the 6 and 12 months survival rate were 67% and 30%, respectively. The median progression free survival (PFS) from re-irradiation was 4.1 month. Our findings suggested that concurrent re-RT with HT was a safe and well-tolerated. In addition, the combination re-RT and HT could be a valuable salvage treatment option for selected recurrent HGG patients with poor performance status.

A Narrative Review of Regional Hyperthermia: Updates From 2010 to 2019

“…HT alone or complementary to CRT is, indeed, feasible for both palliative care and therapeutic purposes, increasing OS and improving quality of life for locally advanced pancreas carcinoma. 70-73…”

“…66 Actually, a standard therapy for recurrent GBM is not yet available; however, emerging results show an advantage of mEHT as an integrative therapy for treatment and not only palliative care of recurrent GBM and astrocytomas (AST; Table 8). 67-73…”

Modulated Electrohyperthermia in Integrative Cancer Treatment for Relapsed Malignant Glioblastoma and Astrocytoma: Retrospective Multicenter Controlled Study

“…12 The absence of a standard treatment exposes the patients to physician choices, which range from surgery (not always indicated) to second-/third-line chemotherapies, re-irradiation, biodegradable carmustine wafers, gene therapy, and mEHT. 12,[15][16][17]19,21,[24][25][26] The method of mEHT is effective in relapsed gliomas because the electric field-induced heating damages the tumor cells 30,31 and increases apoptosis. 32,33 The basis of the hyperthermia effect is that tumor cells are more sensitive than healthy cells to heat with the synergy of an electric field.…”

“…12 The absence of a standard treatment exposes the patients to physician choices, which range from surgery (not always indicated) to second-/third-line chemotherapies, re-irradiation, biodegradable carmustine wafers, gene therapy, and mEHT. 12,15-17,19,21,24-26…”

“…Choosing the therapy after progression is very challenging and options include combinations of surgery, re-irradiation (re-RT), chemotherapy, anti-angiogenic agents, and combination therapies of hyperthermia with chemotherapy or RT. [15][16][17][18] In this case, surgery can be performed only for young and fit patients with small-size relapses.…”