Patterns of relapse in patients with high grade glioma receiving combined treatments including stereotactic re-irradiation for a first relapse

Antoni, D.; Jastaniah, Z.; Haoming, Q. C.; Gaultier, C.; Ahle, Guido; Couchot, J; Atlani, D.; Schött, Roland; Clavier, J.; Srour, Robin; Chaussemy, Dominique; Noël, Georges

doi:10.1016/j.canrad.2016.03.006

Cited by 14 publications

(11 citation statements)

References 29 publications

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“…Patterns of tumor recurrence have been well studied in the last decade 13 , 14 , 21 – 23 . Most studies evaluated four recurrence types according to the classification of Pope et al .…”

Section: Discussionmentioning

confidence: 99%

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Retrospective Analysis of Radiological Recurrence Patterns in Glioblastoma, Their Prognostic Value And Association to Postoperative Infarct Volume

Bette

Barz

Huber

et al. 2018

Sci Rep

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Recent studies suggested that postoperative hypoxia might trigger invasive tumor growth, resulting in diffuse/multifocal recurrence patterns. Aim of this study was to analyze distinct recurrence patterns and their association to postoperative infarct volume and outcome. 526 consecutive glioblastoma patients were analyzed, of which 129 met our inclusion criteria: initial tumor diagnosis, surgery, postoperative diffusion-weighted imaging and tumor recurrence during follow-up. Distinct patterns of contrast-enhancement at initial diagnosis and at first tumor recurrence (multifocal growth/progression, contact to dura/ventricle, ependymal spread, local/distant recurrence) were recorded by two blinded neuroradiologists. The association of radiological patterns to survival and postoperative infarct volume was analyzed by uni-/multivariate survival analyses and binary logistic regression analysis. With increasing postoperative infarct volume, patients were significantly more likely to develop multifocal recurrence, recurrence with contact to ventricle and contact to dura. Patients with multifocal recurrence (Hazard Ratio (HR) 1.99, P = 0.010) had significantly shorter OS, patients with recurrent tumor with contact to ventricle (HR 1.85, P = 0.036), ependymal spread (HR 2.97, P = 0.004) and distant recurrence (HR 1.75, P = 0.019) significantly shorter post-progression survival in multivariate analyses including well-established prognostic factors like age, Karnofsky Performance Score (KPS), therapy, extent of resection and patterns of primary tumors. Postoperative infarct volume might initiate hypoxia-mediated aggressive tumor growth resulting in multifocal and diffuse recurrence patterns and impaired survival.

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“…Patterns of tumor recurrence have been well studied in the last decade 13 , 14 , 21 – 23 . Most studies evaluated four recurrence types according to the classification of Pope et al .…”

Section: Discussionmentioning

confidence: 99%

“…: local, distant, diffuse, multifocal 23 . The predominant type is local tumor recurrence 13 , 21 , 23 – 25 . Whereas local tumor recurrence is associated with a better prognosis, the remaining recurrence patterns are associated with impaired overall survival 15 .…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Radiological Recurrence Patterns in Glioblastoma, Their Prognostic Value And Association to Postoperative Infarct Volume

Bette

Barz

Huber

et al. 2018

Sci Rep

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“…In 1997, Glass et al 20 tested this combined approach of stereotactic radiotherapy and chemotherapy with cisplatin. Since then, several studies that combined HFSRT with various drugs (paclitaxel, TMZ, topotecan, gefitinib, sunitinib, fotemustine, panobinostat, or bevacizumab) 20 , 23 , 27 , 28 , 30 , 33 , 35 - 38 , 40 , 41 , 43 - 46 have been conducted. According to these studies, combined modality management appears to be feasible and well tolerated, and the results are encouraging especially with bevacizumab.…”

Section: Discussionmentioning

confidence: 99%

“…According to these studies, combined modality management appears to be feasible and well tolerated, and the results are encouraging especially with bevacizumab. 33 , 37 , 43 , 45 , 46 The RTOG 1205 randomized phase II trial could shed new light on the efficacy of this strategy and clarify the role of bevacizumab in the management of HGG recurrence.…”

Section: Discussionmentioning

confidence: 99%

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Hypofractionated Stereotactic Radiotherapy as a Salvage Therapy for Recurrent High-Grade Gliomas: Single-Center Experience

Reynaud

Bertaut

Farah

et al. 2018

Technol Cancer Res Treat

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Background and Purpose:The aim of this study was to investigate the survival outcomes and safety of hypofractioned stereotactic radiotherapy as a salvage treatment for recurrent high-grade glioma.Patients and Methods:Between March 2012 and March 2017, 32 consecutive patients (12 women, 20 men) treated in a single center were retrospectively included in this study. Grade III gliomas were diagnosed in 14 patients and grade IV in 18 patients. Thirty-four lesions were treated with hypofractionated stereotactic radiotherapy on a linear accelerator. Hypofractionated stereotactic radiotherapy delivered a median dose of 30 Gy (27-30) in 6 fractions (3-6) of 5 Gy (5-9). The treatment plans were normalized to 100% at the isocenter and prescribed to the 80% isodose line. Clinical outcomes and prognostic factors were analyzed.Results:Median follow-up was 20.9 months. Median overall survival following hypofractionated stereotactic radiotherapy was 15.6 months (median overall survival for patients with glioblastoma and grade III glioma was 8.2 and 19.5 months, respectively; P = .0496) and progression-free survival was 3.7 months (median progression-free survival for patients with glioblastoma and grade III glioma was 3.6 and 4.5 months, respectively; P = .2424). In multivariate analysis, tumor grade III (P = .0027), an Eastern Cooperative Oncology Group status <2 at the time of reirradiation (P = .0023), and a mean dose >35 Gy (P = .0055) significantly improved overall survival. A maximum reirradiation dose above 38 Gy (P = .0179) was significantly associated with longer progression-free survival.Conclusion:Hypofractionated stereotactic radiotherapy is well tolerated and offers an effective salvage option for the treatment of recurrent high-grade gliomas with encouraging overall survival. Our results suggest that the dose distribution had an impact on survival.

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Neuroimaging classification of progression patterns in glioblastoma: a systematic review

et al. 2018

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Patterns of relapse in patients with high grade glioma receiving combined treatments including stereotactic re-irradiation for a first relapse

Cited by 14 publications

References 29 publications

Retrospective Analysis of Radiological Recurrence Patterns in Glioblastoma, Their Prognostic Value And Association to Postoperative Infarct Volume

Retrospective Analysis of Radiological Recurrence Patterns in Glioblastoma, Their Prognostic Value And Association to Postoperative Infarct Volume

Hypofractionated Stereotactic Radiotherapy as a Salvage Therapy for Recurrent High-Grade Gliomas: Single-Center Experience

Neuroimaging classification of progression patterns in glioblastoma: a systematic review

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