Historically, radiation oncologists have approached re-irradiating brain tumours with caution due to the potential risks of central nervous system late toxicity, especially radionecrosis, which may occur months or years following treatment. There is, however, a paucity of prospective data addressing this approach. Re-irradiation of brain tumours is attracting more interest as our understanding of the tolerance of the brain to radiation evolves. Furthermore, developments in radiation treatment approaches, technology and imaging enable highly accurate targeting of biologically relevant tumour volumes. Thanks to recent advancements in molecular-targeted therapy, further exploration of the role of re-irradiation – primary or in combination with novel agents – is needed.
KeywordsKetogenic Diet Stereotactic Radiotherapy Recurrent Glioblastoma Immune Checkpoint Inhibitor Recurrent Glioma
Susan C. Short and Jennifer E. Gains authored the brain tumours chapter for the first edition of this textbook. The present chapter is based on their updated manuscript.
- Armstrong TS, Wefel JS, Wang M et al (2013) Net clinical benefit analysis of radiation therapy oncology group 0525: a phase III trial comparing conventional adjuvant temozolomide with dose-intensive temozolomide in patients with newly diagnosed glioblastoma. J Clin Oncol 31:4076–4084CrossRefPubMedPubMedCentralGoogle Scholar
- Hall EJ, Giaccia AJ (2005) Radiobiology for the radiologist, 6th edn. Lippincott Williams and Wilkins, PhiladelphiaGoogle Scholar
- Martuscello RT, Vedam-Mai V, McCarthy DJ et al. (2015) A supplemented high-fat low-carbohydrate diet for the treatment of glioblastoma. Clin Cancer Res 22:2482–2495Google Scholar
- Quick-Weller J, Lescher S, Forster MT et al (2016) Combination of 5-ALA and iMRI in re-resection of recurrent glioblastoma. Br J Neurosurg 8:1–5Google Scholar
- Sampson JH, Vlahovic G, Sahebjam S et al. (2015) Preliminary safety and activity of nivolumab and its combination with ipilimumab in recurrent glioblastoma (GBM): CHECKMATE-143. J Clin Oncol ASCO Ann Meet Proc 33(3010S)Google Scholar
- Shi W, Palmer JD, Werner-Wasik M et al. (2016) Phase I trial of panobinostat and fractionated stereotactic re-irradiation therapy for recurrent high grade gliomas. J Neurooncol 127:535–539Google Scholar
- Wick A, Felsberg J, Steinbach JP et al (2007) Efficacy and tolerability of temozolomide in an alternating weekly regimen in patients with recurrent glioma. J Clin Oncol 25:3357–3361Google Scholar