Independent validation of a new reirradiation risk score (RRRS) for glioma patients predicting post-recurrence survival: A multicenter DKTK/ROG analysis

Niyazi, Maximilian; Adeberg, Sebastian; Kaul, David; Boulesteix, Anne‐Laure; Bougatf, Nina; Fleischmann, Daniel; Grün, Arne; Krämer, Augustin; Rödel, Claus; Eckert, Franziska; Paulsen, Frank; Kessel, Kerstin A.; Combs, Stephanie E.; Oehlke, Oliver; Grosu, Anca‐Ligia; Seidlitz, Annekatrin; Lattermann, Annika; Krause, Mechthild; Baumann, Michaël; Guberina, Maja; Stuschke, Martin; Budach, Volker; Belka, Claus; Debus, Jürgen

doi:10.1016/j.radonc.2018.01.011

Cited by 44 publications

(36 citation statements)

References 16 publications

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“…Age is a well-established factor in the literature and is used in prognostic indices for predicting outcome in recurrent glioma. 12 , 13 , 14 The prognostic role of KPS has been well established among other authors by Niyazi et al. 14 …”

Section: Discussionmentioning

confidence: 90%

Reirradiation of High-Grade Gliomas: A Retrospective Analysis of 198 Patients Based on the Charité Data Set

Kaul

Pudlitz

Böhmer

et al. 2020

Advances in Radiation Oncology

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Purpose There is no standard of care for recurrent high-grade glioma. Treatment strategies include reresection, reirradiation, systemic agents, intratumoral thermotherapy using magnetic iron-oxide nanoparticles (“nanotherapy”), and tumor treating fields. Only a small number of patients are eligible for reresection, and because many patients receive a full course of radiation therapy, there is fear of reirradiation-induced morbidity. Modern radiation techniques have resulted in greater acceptance of reirradiation. In this work we retrospectively analyzed patients who had undergone reirradiation of high-grade glioma at Charité Universitätsmedizin Berlin. Methods and Materials All patients treated with reirradiation for recurrent high-grade glioma in our department from January 1997 to February 2014 were analyzed in this study. In total, 198 patients were included. The primary endpoint was overall survival after recurrence. Results One hundred ninety-eight patients were identified. Median time from first radiation therapy to reirradiation was 14 months. Median follow-up from the first day of reirradiation to last contact or death was 7 months. Median overall survival after relapse was 7 months for the overall cohort. For glioblastoma, median overall survival after relapse was 6 months and for grade 3 gliomas 14 months. Treatment was generally well tolerated. Common Terminology Criteria for Adverse Events grade 3 toxicity was observed in 5.1% patients and grade 4 toxicity in 2.5%. No patient developed grade 5 toxicity. The likelihood of developing severe toxicity (Common Terminology Criteria for Adverse Events grade 3 or 4) was not significantly higher in the group of patients who received reirradiation in the first 14 months after initial radiation therapy. Patients who received a higher biologically effective dose to the tumor also did not have a significantly higher rate of severe acute toxicity. Conclusions The prognosis of recurrent high-grade glioma remains dismal. Reirradiation is often tolerable even after early recurrence (<14 months) and with higher doses (eg, 49.4 Gy/3.8 Gy) in selected patients.

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Section: Discussionmentioning

confidence: 90%

Reirradiation of High-Grade Gliomas: A Retrospective Analysis of 198 Patients Based on the Charité Data Set

Kaul

Pudlitz

Böhmer

et al. 2020

Advances in Radiation Oncology

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“…In 2018, a new 3-tiered Niyazi score system was developed from an arithmetic formula for re-RT risk score (RRRS) using three parameters (age, WHO grade, and KPS). It was then validated in independent dataset of 212 patients [55]. The median OS of prognostic groups in development cohort were 14.2, 9.1, and 5.3 months.…”

Section: Re-rt Alonementioning

confidence: 99%

Appraisal of re-irradiation for the recurrent glioblastoma in the era of MGMT promotor methylation

Kim

2019

Radiat Oncol J

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Despite recent innovation in treatment techniques and subsequently improved outcomes, the majority of glioblastoma (GBL) have relapses, especially in locoregional areas. Local re-irradiation (re-RT) has been established as a feasible option for recurrent GBL of all ages with safety, tolerability, and effectiveness both in survival and quality of life regardless of fractionation schedule. To keep adverse effects under acceptable range, cumulative dose limit in equivalent dose at 2 Gy fractions by the linear-quadratic model at α/β = 2 for normal brain tissue (EQD2) with narrow margin should be observed and single/hypofractionated re-RT should be undertaken very carefully to recurrent tumor with large volume or adjacent to the brainstem. Promising outcome of re-operation (re-Op) plus re-RT (re-Op/RT) need to be validated and result from re-RT with temozolomide/bevacizumab (TMZ/BV) or new strategy is expected. Development of new-concept prognostic scoring or risk group is required to select patients properly and make use of predictive biomarkers such as O(6)-methylguanine-DNA methyltransferase (MGMT) promotor methylation that influence outcomes of re-RT, re-Op/RT, or re-RT with TMZ/BV.

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“…In metastatic disease, the argument for hypofractionation is clearly driven by the reduced survival times of palliative patients; however, lessons learned from the treatment of vertebral metastases have nicely shown that short hypofractionated treatments such as 5 × 4 Gy or 1 × 8 Gy for vertebral metastases may help for short term pain reduction, but longer-term local control is significantly lower than with 10-13 × 3 Gy, and even higher with 40Gy in 2 Gy fractions [12][13][14][15][16][17][18]. Estimating life expectancy is always controversial, even among advanced health care providers and with the help of high-end diagnostic, molecular markers and prognostic scores, [19][20][21][22][23][24][25]. Now, in our world of high-end radiation oncology service, we are facing a new challenge: keeping our radiation oncology service up and running during the COVID-19 challenge.…”

Section: Introductionmentioning

confidence: 99%

First statement on preparation for the COVID-19 pandemic in large German Speaking University-based radiation oncology departments

et al. 2020

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The COVID-19 pandemic is challenging modern radiation oncology. At University Hospitals, we have a mandate to offer high-end treatments to all cancer patients. However, in times of crisis we must learn to prioritize resources, especially personnel. Compromising oncological outcome will blur all statistics, therefore all measures must be taken with great caution. Communication with our neighboring countries, within societies and between departments can help meet the challenge. Here, we report on our learning system and preparation measures to effectively tackle the COVID-19 challenge in University-Based Radiation Oncology Departments.

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Independent validation of a new reirradiation risk score (RRRS) for glioma patients predicting post-recurrence survival: A multicenter DKTK/ROG analysis

Cited by 44 publications

References 16 publications

Reirradiation of High-Grade Gliomas: A Retrospective Analysis of 198 Patients Based on the Charité Data Set

Reirradiation of High-Grade Gliomas: A Retrospective Analysis of 198 Patients Based on the Charité Data Set

Appraisal of re-irradiation for the recurrent glioblastoma in the era of MGMT promotor methylation

First statement on preparation for the COVID-19 pandemic in large German Speaking University-based radiation oncology departments

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