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Re-irradiation in elderly patients with glioblastoma: a single institution experience

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Abstract

Background

Re-Irradiation (Re-RT) is an established treatment option for young patients with recurrent glioblastoma (GBM). Multiple reports show a low risk of side-effects as well as a good efficacy resulting in median survival times ranging from 5 to 18 months. Elderly patients, however, are underrepresented in reports about Re-RT. Even in the elderly, with concomitant radiochemotherapy and adjuvant chemotherapy, progression-free survival times now are approaching 6 months or even longer.

Methods

We report on 25 consecutive patients with at least 65 years of age treated with Re-RT for recurrent GBM. We analyzed the patient’s files for the treatment regimens, side-effects and survival times. Survival times, as well as hazards, were calculated by the Kaplan Meier method as well as Cox-regression method, respectively.

Results

The median overall survival was 6.9 months, treatment was well tolerated with only minor side effects. Use of systemic treatments as well as the length of the interval between 1st -line radiotherapy and re-irradiation were associated with a favorable prognosis. The latter remained significant after multivariate analysis.

Conclusion

Re-RT of elderly GBM patients should not be withheld based purely on age since the treatment is safe and results in comparable survival times to younger patients. When counseling elderly patients with recurrent GBM, especially the length of the interval since 1st line radiotherapy should be considered as a prognostic factor and an additional systemic treatment option should be considered.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

To our patients.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, 81675, Munich, Germany

    Christoph Straube, Stefanie Antoni & Stephanie E. Combs

  2. Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany

    Christoph Straube & Stephanie E. Combs

  3. Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany

    Jens Gempt & Bernhard Meyer

  4. Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany

    Claus Zimmer

  5. Institut for Pathology, Department of Neuropathology, Technical University of Munich (TUM), Munich, Germany

    Jürgen Schlegel

  6. Department of Neurology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany

    Stefanie Antoni & Friederike Schmidt-Graf

  7. Department of Radiation Sciences (DRS), Institute for Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany

    Stephanie E. Combs

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  1. Christoph Straube
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Contributions

CS designed the study, collected and analyzed the data and prepared the manuscript. SA collected some data and revised the manuscript. FSG, JG, CZ, JS, and BM gave important intellectual input and carefully revised the manuscript. SC supervised the work and revised the manuscript. All authors approved the final version for submission.

Corresponding author

Correspondence to Christoph Straube.

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Conflict of interest

Christoph Straube: received a scholarship from Medac GmbH; received a travel grant from NovoCure Ltd.; contributed to a brochure for patients about GBM which was partially sponsored by NovoCure Ltd. Received Speakers Honoria from Teva Pharmaceutical Industries Ltd. Jens Gempt and Bernhard Meyer: work as consultants for BrainLab. Friederike Schmidt-Graf: served as an author for Medac GmbH. Claus Zimmer: has served on scientific advisory boards for Philips and Bayer Schering; serves as co-editor on the Advisory Board of Clinical Neuroradiology; has received speaker honoraria from Bayer-Schering and Philips and has received research support and investigator fees for clinical studies from Biogen Idec, Quintiles, MSD Sharp & Dome, Boehringer Ingelheim, Inventive Health Clinical UK Ltd., Advance Cor, Brainsgate, Pfizer, Bayer-Schering, Novartis, Roche, Servier, Penumbra, WCT GmbH, Syngis, SSS International Clinical Research, PPD Germany GmbH, Worldwide Clinical Trials Ltd., Phenox, Covidien, Actelion, Medivation, Medtronic, Harrison Clinical Research, Concentric, Penumbra, Pharmtrace, Reverse Medical Corp., Premier Research Germany Ltd., Surpass Medical Ltd. and GlaxoSmithKline. Stephanie E. Combs: has served on Advisory Board of Bristol-Myers-Squibb (BMS), Roche, Novocure, Daiichi Synkio, Astra Zeneca, Icotec; Advisory board and Speaker’s Bureau for BrainLab; Advisory Board of Roche, Daiichi Sankyo and Varian Medial Systems. Has received Speakers Honoraria from BrainLab, Accuray, Dr. Sennewald, BMS, Astra Zeneca, Roche, Varian Medical Systems, Icotec, Elekta, Novocure and Medac GmbH. Stefanie Antoni has nothing to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. We obtained a positive ethical vote of the ethical committee at Klinikum rechts der Isar, Technical University of Munich (Project Number 408/14).

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Straube, C., Antoni, S., Gempt, J. et al. Re-irradiation in elderly patients with glioblastoma: a single institution experience. J Neurooncol 142, 327–335 (2019). https://doi.org/10.1007/s11060-019-03101-6

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