Re‐irradiation of recurrent gliomas: pooled analysis and validation of an established prognostic score—report of the Radiation Oncology Group (ROG) of the German Cancer Consortium (DKTK)

Abstract

The heterogeneity of high‐grade glioma recurrences remains an ongoing challenge for the interdisciplinary neurooncology team. Response to re‐irradiation (re‐RT) is heterogeneous, and survival data depend on prognostic factors such as tumor volume, primary histology, age, the possibility of reresection, or time between primary diagnosis and initial RT and re‐RT. In the present pooled analysis, we gathered data from radiooncology centers of the DKTK Consortium and used it to validate the established prognostic score by Combs et al. and its modification by Kessel et al. Data consisted of a large independent, multicenter cohort of 565 high‐grade glioma patients treated with re‐RT from 1997 to 2016 and a median dose of 36 Gy. Primary RT was between 1986 and 2015 with a median dose of 60 Gy. Median age was 54 years; median follow‐up was 7.1 months. Median OS after re‐RT was 7.5, 9.5, and 13.8 months for WHO IV, III, and I/II gliomas, respectively. All six prognostic factors were tested for their significance on OS. Aside from the time from primary RT to re‐RT (P = 0.074) and the reresection status (P = 0.101), all factors (primary histology, age, KPS, and tumor volume) were significant. Both the original and new score showed a highly significant influence on survival with P < 0.001. Both prognostic scores successfully predict survival after re‐RT and can easily be applied in the routine clinical workflow. Now, further prognostic features need to be found to even improve treatment decisions regarding neurooncological interventions for recurrent glioma patients.

Combining multimodal imaging and treatment features improves machine learning‐based prognostic assessment in patients with glioblastoma multiforme

“…Despite intensive efforts in research, the success of current therapy regimens remains limited with low two‐year survival rates of 16.9% . We know that clinical parameters such as younger age, high Karnofsky‐performing status (KPS) indices, and female gender correlate with a favorable outcome . Several approaches finding molecular determinants of outcome to predict treatment response have been published.…”

Low Fraction Size Re-irradiation for Large Volume Recurrence of Glial Tumours

“…Selected studies on SRS for small volume recurrences of median 6.2 to 28.0 cm 3 [27][28][29] showed an improvement on median survival ranging from 5.3 to 13.0 months with associated radionecrosis of 0-31.3%. Others have reported their results for recurrent GBM volumes of median 7-50 cm 3 applying FSRT resulted in median survival within the range of 6.5-11 months [26,[30][31][32]. In contrast to these small target volumes for re-RT with SRS techniques, lower doses to larger volumes could be applied safely with acceptable efficacy, which was confirmed by the first meta-analysis on re-irradiation published by Kazmi et al [17].…”

<p>Carbon Ion Beam Reirradiation in Recurrent High-Grade Glioma</p>

“…In the report by Combs et al on reirradiation in recurrent glioma, the extent of resection and age at primary diagnosis wereamong others -significant factors for OS. 3 In addition, Minniti et al reported initial MGMT methylation status to be the only prognostic factor for OS using multivariate analysis. 13 However, in the study by Scholtyssek et al on reirradiation in 64 patients with recurrent high-grade glioma, multivariate analysis on OS revealed female gender, age < 50 years, WHO grade 3 histology, KPS ≥70% and complete resection prior to reirradiation to be positive prognostic factors.…”

“…2 Median overall survival (OS) after reirradiation for recurrent glioma lies between 6 and 10.7 months. [3][4][5][6] Carbon ions have different radiobiological effects that might have the potential to overcome radioresistence. 7,8 For example, carbon ions were able to eradicate hypoxic and stem celllike tumor cells and create an antiangiogenic and less immunosuppressive state.…”

“…Recent developments in prognostic scoring systems for patient selection for reirradiation might help to further optimize the management in recurrent glioma. 3,4 It was our aim to retrospectively assess the outcome and toxicity of patients with recurrent high-grade glioma consecutively treated with carbon ion beam reirradiation at the Marburg Ion-Beam Therapy Center.…”