Abstract
Purpose:To assess the effectiveness of re-irradiation in recurrent low-grade gliomas (LGG). Patients and methods:Sixty-three patients were treated with fractionated stereotactic re-irradiation in the case of recurrent gliomas. At primary diagnosis of the tumor, the histology was grade II astrocytoma, oligodendroglioma or oligoastrocytoma. Fifty-two (82.5%) recurrences were in-field, three (4.8%) were localized at the field border, and eight (12.7%) tumors were localized completely out-field of the former RT field, respectively. Using three to four irregular non-coplanar fields formed with a multi-leaf-collimator, we applied a median total dose of 36 Gy (range 15--62 Gy)with a weekly fractionation of 5 × 2 Gy/week depending on the size and the location of the lesion. No concomitant chemotherapy was applied. Results:Radiation was well tolerated by all patients. No severe side effects occurred. Median overall survival was 111 months (range 12--240 months). Extent of neurosurgical resection significantly influenced overall survival (P=0.02). Median interval between the first radiation therapy and re-irradiation was 50 months (range 5--204 months). From the time point of re-irradiation, median survival was 23 months. Median progression-free survival from the time point of re-irradiation was 12 months (range 2--63 months). No prognosticators could be identified for survival from re-irradiation and progression free survival. Conclusion:Our retrospective data suggest that stereotactically guided fractionated re-irradiation in recurrent glioma represents an effective treatment option with good results and few complications. However, further investigation is warranted to consolidate these results and to combine radiation with chemotherapy in the case of recurrent LGG.
Similar content being viewed by others
References
DR MacDonald (1994) ArticleTitleLow-grade gliomas, mixed gliomas and oligodendrogliomas Semin Oncol 21 236–248 Occurrence Handle1:STN:280:ByuB3cvmvVE%3D Occurrence Handle8153667
EG Shaw (1990) ArticleTitleLow-grade gliomas: to treat or not to treat A radiation oncologist’s viewpoint. Arch Neurol 46 1138–1139
DM Garcia KH Fullin JE Marks (1985) ArticleTitleThe value of radiation therapy in addition to surgery for astrocytomas of the adult cerebrum Cancer 55 919–927
K Lote AE Stenwig K Skullerud H Hirschberg (1998) ArticleTitlePrevalence and prognostic significance of epilepsy in patients with glioma Eur J Cancer 34 98–102
C Leighton B Fisher G Baumann et al. (1997) ArticleTitleSupratentorial low-grade glioma in adults: An analysis of prognostic factors and timing of radiation J Clin Oncol 15 1294–1301
M Berger A Deliganiz J Dobbins et al. (1994) ArticleTitleThe effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas Cancer 74 1784–1791
Cairncross JG, Laperriere NJ: Low-grade glioma: to treat or not to treat? Arch Neurol 46: 1238 (editorial) 1990.
EG Shaw C Daumas-Dupoert BW Scheithauer et al. (1989) ArticleTitleRadiation therapy in the management of low-grade supratentorial astrocytomas J Neurosurg 70 853–861
Laws ER Jr, Taylor WF, Clifton MB et al.: Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres. J Neurosurg 61: 665–673. 1984.
Y Shibamoto Y Kitkabu M Takahashi et al. (1993) ArticleTitleSupratentorial low-grade astrocytoma Cancer 92 190–195
M Nakamura N Konishi S Tsunoda et al. (2000) ArticleTitleAnalysis of prognostic factors and survival factors related to treatment of low-grade astrocytomas in adults Oncology 58 108–116
AB Karim D Afra P Cornu N Bleehan S Schraub O Witte ParticleDe F Darcel S Stenning M Pierart M Glabbeke ParticleVan (2002) ArticleTitleRandomized trial on the efficacy of radiotherapy for cerebral low-grade glioma in the adult: European Organization for Research and Treatment of Cancer Study 22845 with the Medical Research Council study BRO4: an interim analysis Int J Radiat Oncol Biol Phys 52 IssueID2 316–324
KE Wallner JH Galicich G Krol et al. (1989) ArticleTitlePatterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma Int J Radiat Biol Phys 16 1405–1509
P Dirks M Bernstein PJ Müller et al. (1993) ArticleTitleThe value of re-operation for recurrent glioblastoma Can J Surg 36 271–275
GR IV Harsh VA Levin PH Gutin et al. (1987) ArticleTitleReoperation for recurrent glioblastoma and anaplastic astrocytoma Neurosurgery 21 615–621
HJ Eyre JJ Crowley JJ Townsend JR Eltringham RA Morantz SF Schulman JM Quagliana M al-Sarraf (1993) ArticleTitleA randomized trial of radiotherapy versus radiotherapy plus CCNU for incompletely resected low-grade gliomas: a Southwest Oncology Group study J Neurosurg 78 IssueID6 909–914
MJ Bent ParticleVan den MJ Taphorn AA Brandes J Menten R Stupp M Frenay et al. (2003) ArticleTitlePhase II study of first-line chemotherapy with temozolomide in recurrent oligodendroglial tumors: the European Organization for Research and Treatment of Cancer Brain Tumor Group Study 26971 J Clin Oncol 21 IssueID13 2525–2528 Occurrence Handle10.1200/JCO.2003.12.015 Occurrence Handle12829671
MJ Bent ParticleVan den O Chinot W Boogerd et al. (2003) ArticleTitleSecond-line chemotherapy with temozolomide in recurrent oligodendroglioma after PCV (procarbazine, lomustine and vincristine) chemotherapy: EORTC Brain Tumor Group phase II study 26972 Ann Oncol 14 IssueID4 599–602
KA Jaeckle KR Hess WK Yung H Greenberg H Fine et al. (2003) ArticleTitlePhase II evaluation of temozolomide and 13-cis-retinoic acid for the treatment of recurrent and progressive malignant glioma: a North American Brain Tumor Consortium study J Clin Oncol 21 IssueID12 2305–2311
JC Buckner (2003) ArticleTitleFactors influencing survival in high-grade gliomas Semin Oncol 30 IssueID6 Suppl 19 10–14
KH Cho WA Hall BJ Gerbi PD Higgins WA McGuire HB Clark (1999) ArticleTitleSingle dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas Int J Radiat Oncol Biol Phys 45 IssueID5 1133–1141
LE Gaspar LJ Zamorano F Shamsa J Fontanesi GE Ezzell DA Yakar (1999) ArticleTitlePermanent 125 iodine implants for recurrent malignant gliomas Int J Radiat Oncol Biol Phys 43 IssueID5 977–982
Combs SE, Gutwein S, Thilmann Ch, Huber P, Debus J, Schulz-Ertner D: Stereotactic radiation therapy for recurrent glioblastoma, submitted for publication.
M Kampen ParticleVan R Engenhart-Cabilic J Debus et al. (1996) ArticleTitleLow-grade astrocytoma: treatment with conventionally fractionated stereotactic radiation therapy Radiology 201 275–278
A Höss J Debus R Bendl R Engenhadt-Cabillic W Schlegel (1995) ArticleTitleComputerized procedures in 3-dimensional radiotherapy planning Radiologe 35 583–586
EL Kaplan P Meier (1958) ArticleTitleNonparametric estimation from incomplete observations J Am Stat Assoc 53 457–481
TG Clark MJ Bradburn SB Love DG Altman (2003) ArticleTitleSurvival analysis part I: basic concepts and first analyses Br J of Cancer 89 232–238
M Brada R Laing (1994) Radiosurgery/stereotactic external bean radiotherapy for malignant brain tumors. The Royal Marsden experience OD Wiestler U Schlegel J Schramm (Eds) Molecular Neuro-oncology and its Impact on the Clinical Management of Brain Tumors Springer Verlag Berlin 91–103
KK Herfarth S Gutwein J Debus (2001) ArticleTitlePostoperative radiotherapy of astrocytomas Semin Surg Oncol 20 13–23
D Schulz-Ertner J Debus F. Lohr et al. (2000) ArticleTitleFractionated stereotactic conformal radiation therapy of brain stem gliomas: outcome and prognostic factors Radiother Oncol 57 215–223
P Janny H Cure M Mohr N Heldt F Kwiatkowski JJ Lemaire R Plagne R Rozan (1994) ArticleTitleLow grade supratentorial astrocytomas Management and prognostic factors. Cancer 73 IssueID7 1937–1945
EG Shaw (1995) ArticleTitleThe low-grade glioma debate: evidence defending the position of early radiation therapy Clin Neurosurg 42 488–494
KH Henderson EG Shaw (2001) ArticleTitleRandomized trials of radiation therapy in adult low-grade gliomas Semin Radiat Oncol 11 IssueID2 145–151 Occurrence Handle10.1053/srao.2001.21424 Occurrence Handle1:STN:280:DC%2BD3MzlsFSmsQ%3D%3D Occurrence Handle11285552
C Plathow D Schulz-Ertner C Thilmann I Zuna M Lichy MA Weber HP Schlemmer M Wannenmacher J Debus (2003) ArticleTitleFractionated Stereotactic Radiotherapy in low-grade astrocytomas: long-term outcome and prognostic factors Int J Rad Oncol Biol Phys 57 IssueID4 996–1003
PK Sneed PH Gutin DA Larson MK Malec TL Phillips MD Prados CO Scharfen KA Weaver WM Wara (1994) ArticleTitlePatterns of recurrence of glioblastoma multiforme after external irradiation followed by implant boost Int J Rad Oncol Biol Phys 29 719–727
J Piepmeier S Christopher D Spencer T Byrne J Kim JP Knisel J Lacy L Tsukerman R Makuch (1996) ArticleTitleVariations in the natural history and survival of patients with supratentorial low-grade astrocytomas Neurosurgery 38 IssueID5 872–828 Occurrence Handle1:STN:280:BymB1cfnsVQ%3D Occurrence Handle8727811
JD Olson E Riedel LM DeAngelis (2000) ArticleTitleLong-term outcome of oligodendroglioma and mixed-glioma Neurology 54 1442–1448 Occurrence Handle1:STN:280:DC%2BD3c3hsFSnug%3D%3D Occurrence Handle10751254
JD Cairncross (2000) ArticleTitleUnderstanding low-grade glioma: a decade of progress Neurology 54 1402–1403
E Shaw R Arusell B Scheithauer J O’Fallon B O’Neill R Dinapoli D Nelson J Earle C Jones T Cascino D Nichols R Ivnik R Hellman W Curran R Abrams (2002) ArticleTitleProspective randomized trial of low-versus high-dose radiation therapy in adults with supratentorial low-grade glioma: initial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study J Clin Oncol 20 IssueID9 2267–2276 Occurrence Handle10.1200/JCO.2002.09.126 Occurrence Handle1:STN:280:DC%2BD383ktlektg%3D%3D Occurrence Handle11980997
FW Kreth M Faist R Rossner B Volk CB Ostertag (1997) ArticleTitleSupratentorial World Health Organization Grade 2 astrocytomas and oligoastrocytomas A new pattern of prognostic factors. Cancer 79 IssueID2 370–379
ML Veelen Particlevan CJ Avezaat JM Kros W Putten Particlevan C Vecht (1998) ArticleTitleSupratentorial low grade astrocytoma: prognostic factors, dedifferentiation, and the issue of early versus late surgery J Neurol Neurosurg Psychiatry 64 IssueID5 581–587
M Scerrati R Roselli M Iacoangeli A Pompucci GF Rossi (1996) ArticleTitlePrognostic factors in low grade (WHO grade II) gliomas of the cerebral hemispheres: the role of surgery J Neurol Neurosurg Psychiatry 61 IssueID3 291–296
G Cairncross D Macdonald S Ludwin et al. (1994) ArticleTitleChemotherapy for anaplastic oligodendroglioma J Clin Oncol 12 2013–2021 Occurrence Handle1:STN:280:ByqD3Mnos1c%3D Occurrence Handle7931469
N Paleologos D Macdonald NA Vick JG Cairncross (1999) ArticleTitleNeoadjuvant procarbazine, CCNU, and vincristine for anaplastic and aggressive oligodendroglioma Neurology 53 1141–1143
JA Quinn DA Reardon AH Friedman et al. (2003) ArticleTitlePhase II trial of temozolomide in patients with progressive low-grade glioma J Clin Oncol 21 646–651
A Pace A Vidri F Cattani et al. (2002) Temozolomide chemotherapy for progressive low grade glioma. Neuro-Oncol 4 S71 (abstr)
MJ Bent ParticleVan den O Chinot W Boogerd J Bravo Marques MJB Taphoorn JM Kros CCD Rijt ParticleVan der CJ Vecht N Beule ParticleDe B Baron (2003) ArticleTitleSecond-line chemotherapy with temozolomide in recurrent oligodendroglioma after PCV (procarbazine, lomustine and vincristine) chemotherapy: EORTC Brain Tumor Group phase II study 26972 Ann Oncol 14 599–602
SF Shepherd RW Laing VP Cosgrove AP Warrington F Hines SE Ashley M Brada (1997) ArticleTitleHypofractionated stereotactic radiotherapy in the management of recurrent glioma Int J Radiat Oncol Biol Phys 15; 37 IssueID2 393–398
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Combs, S.E., Ahmadi, R., Schulz-Ertner, D. et al. Recurrent low-grade gliomas: the role of fractionated stereotactic re-irradiation. J Neurooncol 71, 319–323 (2005). https://doi.org/10.1007/s11060-004-2029-z
Issue Date:
DOI: https://doi.org/10.1007/s11060-004-2029-z