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Hypofractionated reirradiation for recurrent malignant glioma

Hypofraktionierte Rebestrahlung bei rezidivierten malignen Gliomen

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Background and Purpose:

Treatment options for recurrent high-grade glioma after a complete course of radiotherapy comprise surgery, reirradiation and chemotherapy but the efficacy of any of the given salvage treatments is limited. In order to further define the role of short-term radiotherapy as retreatment option for selected patients, we analyzed outcomes after treatment with a hypofractionated radiation.

Patients and Methods:

Treatment outcomes (overall survival and treatment-associated toxicity) were analyzed retrospectively in 31 patients treated between 1994 and 2007. Hypofractionated radiotherapy was performed after three-dimensional CT planning with a median total dose of 20 Gy in a single department.

Results:

With a median interval of 20 months from primary radiotherapy, two grade III and 29 grade IV tumors were reirradiated. Pretreatment consisted of surgery and involved-field radiotherapy (median 59 Gy). 77% of the patients received additional chemotherapy before the second course of radiotherapy, and 48% were treated after secondary resection. The median overall survival after hypofractionated radiotherapy was 10.2 months, and the median overall survival time after primary diagnosis 30.9 months. No severe toxicity was observed.

Conclusion:

Hypofractionated reirradiation with 20 Gy given over 1 week is a practicable and well-tolerated treatment option for patients with recurrent malignant glioma. The overall survival was comparable to the reported outcomes from other series including those with longer treatment protocols.

Hintergrund und Ziel:

Die aktuellen Behandlungsoptionen bei Rezidiv eines vorbestrahlten hochmalignen Glioms beinhalten Operation, Strahlentherapie und Chemotherapie. Allerdings ist die Wirksamkeit der gegebenen Salvage-Behandlungen begrenzt. Um die Rolle einer kurzzeitigen Rebestrahlung bei ausgewählten Patienten weiter zu definieren, wurden Krankheitsverläufe bei Patienten nach Behandlung mit einem kurzzeitigen hypofraktionierten Bestrahlungskonzept analysiert.

Patienten und Methodik:

Die Verläufe (Gesamtüberleben und Toxizität) von 31 zwischen 1994 und 2007 behandelten Patienten wurden retrospektiv analysiert. Die hypofraktionierte Strahlentherapie wurde nach dreidimensionaler CT-Planung mit einer mittleren Gesamtdosis von 20 Gy in einer einzelnen Abteilung durchgeführt.

Ergebnisse:

Bei zwei Grad-III- und 29 Grad-IV-Tumoren wurde mit einem mittleren Abstand von 20 Monaten nach der primären Strahlentherapie eine Rebestrahlung durchgeführt. Die Vorbehandlung bestand in Operation und Involved-Field-Strahlentherapie (Median 59 Gy). 77% der Patienten erhielten vor dem zweiten Strahlentherapiekurs zusätzlich eine Chemotherapie, und 48% wurden nach erneuter Resektion behandelt. Das mittlere Gesamtüberleben nach hypofraktionierter Strahlentherapie betrug 10,2 Monate und das mittlere Gesamtüberleben nach Primärdiagnose 30,9 Monate. Schwere Toxizitäten wurden nicht beobachtet.

Schlussfolgerung:

Die hypofraktionierte Rebestrahlung mit 20 Gy über eine Woche ist eine praktikable und gut verträgliche Behandlungsform für Patienten mit Rezidiv eines hochgradigen malignen Glioms. Das Gesamtüberleben war mit den in der Literatur berichteten Resultaten anderer Serien einschließlich jener mit längeren Bestrahlungsprotokollen vergleichbar.

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Authors and Affiliations

  1. Department of Radiooncology, University Hospital, Tübingen, Germany

    Guido Henke, Frank Paulsen, Hana Isijanov & Michael Bamberg

  2. Dr. Senckenbergisches Institut für Neuroonkologie, Center of Neurology and Neurosurgery, University Hospital, J.W. Goethe University, Frankfurt/Main, Germany

    Joachim P. Steinbach

  3. Department of Radiooncology, Ludwig-Maximilian University, Munich, Germany

    Ute Ganswindt & Claus Belka

  4. Department of Radiotherapy and Radiooncology, University Hospital, Leipzig, Germany

    Rolf-Dieter Kortmann

  5. Klinik für Radioonkologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany

    Guido Henke

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  1. Guido Henke
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Correspondence to Guido Henke.

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Henke, G., Paulsen, F., Steinbach, J.P. et al. Hypofractionated reirradiation for recurrent malignant glioma. Strahlenther Onkol 185, 113–119 (2009). https://doi.org/10.1007/s00066-009-1969-9

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  • DOI: https://doi.org/10.1007/s00066-009-1969-9

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