Re-irradiation alternatives for recurrent high-grade glioma

Abstract

Despite advances in the fields of surgery, chemotherapy and radiotherapy, the prognosis for high-grade glioma (HGG) remains unsatisfactory. The majority of HGG patients experience disease recurrence. To date, no standard treatments have been established for recurrent HGG. Repeat surgery and chemotherapy demonstrate moderate efficacy. As recurrent lesions are usually located within the previously irradiated field, a second course of irradiation was once considered controversial, as it was considered to exhibit unsatisfactory efficacy and radiation-related toxicities. However, an increasing number of studies have indicated that re-irradiation may present an efficacious treatment for recurrent HGG. Re-irradiation may be delivered via conventionally fractionated stereotactic radiotherapy, hypofractionated stereotactic radiation therapy, stereotactic radiosurgery and brachytherapy techniques. In the present review, the current literature regarding re-irradiation treatment for recurrent HGG is summarized with regard to survival outcome and side effects.

Patterns of re-irradiation for recurrent gliomas and validation of a prognostic score

“…The cohort was subdivided into three treatment categories, according to daily fraction size. CFRT was defined as a fractional dose up to 3 Gy, HFRT including 3 to 5 Gy and SRT 5 Gy or more, in analogy to Dong et al [21] and Koontz et al [22].…”

Can Hypofractionated Reirradiation Plus Temozolamide Be a Wise Choice for Recurrent High and Low Grade Brain Tumors?

“…In a rewiev done by Dong et al (2016) the range for survival after reirradiation was given as 7.4 − 16.5 months. In our study the survival after reirradiation (ReRTS) was 9.83 months.…”

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

“…The standard of care for patients with recurrent GBM or grade III glioma has not yet been clearly defined, and many approaches are available for salvage strategies, including surgery, reirradiation, or systemic agents. 10 - 18 …”

“…For the treatment of HGG recurrence by radiotherapy, many approaches have been studied, including brachytherapy, single-fraction radiosurgery, hypofractionated stereotactic radiotherapy (HFSRT), or conventional fractionated radiotherapy 10 - 18 ; however, none of these treatments demonstrated significant improvement in a phase III study.…”