Reirradiation in progressive high-grade gliomas: outcome, role of concurrent chemotherapy, prognostic factors and validation of a new prognostic score with an independent patient cohort

Abstract

PurposesFirst, to evaluate outcome, the benefit of concurrent chemotherapy and prognostic factors in a cohort of sixty-four high-grade glioma patients who underwent a second course of radiation therapy at progression. Second, to validate a new prognostic score for overall survival after reirradiation of progressive gliomas with an independent patient cohort.Patients and methodsAll patients underwent fractionated reirradiation with a median physical dose of 36 Gy. Median planned target volume was 110.4 ml. Thirty-six patients received concurrent chemotherapy consisting in 24/36 cases (67%) of carboplatin and etoposide and in 12/36 cases (33%) of temozolomide. We used the Kaplan Meier method, log rank test and proportional hazards regression analysis for statistical assessment.ResultsMedian overall survival from the start of reirradiation was 7.7 ± 0.7 months. Overall survival rates at 6 and 12 months were 60 ± 6% and 24 ± 6%, respectively. Despite relatively large target volumes we did not observe any major acute toxicity. Concurrent chemotherapy did not appear to improve outcome. In contrast, female gender, young age, WHO grade III histology, favorable Karnofsky performance score and complete resection of the tumor prior to reirradiation were identified as positive prognostic factors for overall survival. We finally validated a recent suggestion for a prognostic score with our independent but small patient cohort. Our preliminary findings suggest that its ability to discriminate between different prognostic groups is limited.ConclusionsOutcome of our patients was comparable to previous studies. Even in case of large target volumes reirradiation seems to be feasible without observing major toxicity. The benefit of concurrent chemotherapy is still elusive. A reassessment of the prognostic score, tested in this study, using a larger patient cohort is needed.

Validation of an established prognostic score after re-irradiation of recurrent glioma

“…Several groups thereafter recognized the potential value of such a scoring system in the clinical setting. In 2012, Scholtyssek et al [10] analyzed 64 patients with high-grade gliomas and could not confirm the significant difference in survival of the different scoring groups. Niyazi et al [9] validated the Combs Prognostic Score on 30 patients with high-and low-grade tumors in 2014, and also found no significant influence on OS (p ¼ 0.664).…”

“…Comparative analyses with other scoring approaches have revealed conflicting results, with a different value of each score [9,10]. However, the choice of Re-RT is made on a caseby-case basis, and solid data or scoring schemes including patient-related data, molecular data and/or other individual information might be useful in the future to stratify patient subgroups.…”

Brain tumor immunotherapy. What have we learned so far?

“…A recent review pointed to the progression-free survival (PFS) at 6 month and median OS as most useful and accessible end points, the latter ranging between 5 and 13 months for relapsed GBM patients (8). The prognosis upon recurrence might be improving with the initiation of new multimodal treatment strategies (9)(10)(11). Most reports are not yet focusing on long-term survival.…”

Re-irradiation or re-operation followed by dendritic cell vaccination? Comparison of two different salvage strategies for relapsed high-grade gliomas by means of a new prognostic model

“…The dataset was collected from four different hospitals, namely the University Hospital of Leipzig (Germany) (n = 64 patients), the University Hospital of Tübingen (Germany) (n = 31 patients), the Cantonal Hospital of St. Gallen (Switzerland) (n = 13 patients) and the University Hospital of Maastricht (The Netherlands) (n = 57 patients). Characteristics and outcome of the patients from Leipzig, Tübingen and St. Gallen have already been published [10][11][12]. Of note, a significant proportion of the re-irradiated patients also underwent ReOP.…”