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A Second Course of Radiotherapy in Patients with Recurrent Malignant Gliomas: Clinical Data on Re-irradiation, Prognostic Factors, and Usefulness of Digital Biomarkers

  • Neuro-oncology (GJ Lesser, Section Editor)
  • Published:
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Opinion Statement

The treatment of malignant gliomas has undergone a significant intensification during the past decade, and the interdisciplinary treatment team has learned that all treatment opportunities, including surgery and radiotherapy (RT), also have a central role in recurrent gliomas. Throughout the decades, re-irradiation (re-RT) has achieved a prominent place in the treatment of recurrent gliomas. A solid body of evidence supports the safety and efficacy of re-RT, especially when modern techniques are used, and justifies the early use of this regimen, especially in the case when macroscopic disease is present. Additionally, a second adjuvant re-RT to the resection cavity is currently being investigated by several investigators and seems to offer promising results. Although advanced RT technologies, such as stereotactic radiosurgery (SRS), fractionated stereotactic radiotherapy (FSRT), intensity-modulated radiotherapy (IMRT), and image-guided radiotherapy (IGRT) have become available in many centers, re-RT should continue to be kept in experienced hands so that they can select the optimal regimen, the ideal treatment volume, and the appropriate techniques from their tool-boxes. Concomitant or adjuvant use of systemic treatment options should also strongly be taken into consideration, especially because temozolomide (TMZ), cyclohexyl-nitroso-urea (CCNU), and bevacizumab have shown a good safety profile; they should be considered, if available. Nonetheless, the selection of patients for re-RT remains crucial. Single factors, such as patient age or the progression-free interval (PFI), fall too short. Therefore, powerful prognostic scores have been generated and validated, and these scores should be used for patient selection and counseling.

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Authors and Affiliations

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

    Christoph Straube, Kerstin A. Kessel & Stephanie E. Combs MD

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

    Christoph Straube, Kerstin A. Kessel & Stephanie E. Combs MD

  3. Institute for Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany

    Christoph Straube, Kerstin A. Kessel & Stephanie E. Combs MD

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

    Claus Zimmer & Jürgen Schlegel

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

    Friederike Schmidt-Graf

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

    Jens Gempt & Bernhard Meyer

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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., and received speakers honoria from Teva Pharmaceutical Industries Ltd. and Roche. Kerstin A. Kessel declares that she has no conflict of interest. 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 & Dohme, 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. Friederike Schmidt-Graf served as an author for Medac GmbH. Jürgen Schlegel declares that he has no conflict of interest. Jens Gempt serves as a consultant for BrainLab. Bernhard Meyer serves as a consultant for BrainLab. Stephanie E. Combs has served on advisory boards of Bristol-Myers Squibb (BMS), Roche, Novocure, Daiichi Synkio, Astra Zeneca, Icotec, and Varian Medical Systems; has served on an advisory board and speaker’s bureau for BrainLab; and has received speaker’s honoraria from BrainLab, Accuray, Dr. Sennewald, BMS, Astra Zeneca, Roche, Varian Medical Systems, Icotec, Elekta, Novocure, and Medac GmbH.

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Straube, C., Kessel, K.A., Zimmer, C. et al. A Second Course of Radiotherapy in Patients with Recurrent Malignant Gliomas: Clinical Data on Re-irradiation, Prognostic Factors, and Usefulness of Digital Biomarkers. Curr. Treat. Options in Oncol. 20, 71 (2019). https://doi.org/10.1007/s11864-019-0673-y

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