Hypofractionated Stereotactic Radiation Therapy in Recurrent High-Grade Glioma: A New Challenge

Pierina Navarria, Anna Maria Ascolese, Stefano Tomatis, Giacomo Reggiori, Elena Clerici, Elisa Villa, Giulia Maggi, Lorenzo Bello, Federico Pessina, Luca Cozzi, Marta Scorsetti, Pierina Navarria, Anna Maria Ascolese, Stefano Tomatis, Giacomo Reggiori, Elena Clerici, Elisa Villa, Giulia Maggi, Lorenzo Bello, Federico Pessina, Luca Cozzi, Marta Scorsetti

Abstract

Purpose: The aim of this study was to evaluate outcomes of hypofractionated stereotactic radiation therapy (HSRT) in patients re-treated for recurrent high-grade glioma.

Materials and methods: From January 2006 to September 2013, 25 patients were treated. Six patients underwent radiation therapy alone, while 19 underwent combined treatment with surgery and/or chemotherapy. Only patients with Karnofsky Performance Status (KPS) > 70 and time from previous radiotherapy greater than 6 months were re-irradiated. The mean recurrent tumor volume was 35 cm(3) (range, 2.46 to 116.7 cm(3)), and most of the patients (84%) were treated with a total dose of 25 Gy in five fractions (range, 20 to 50 Gy in 5-10 fractions).

Results: The median follow-up was 18 months (range, 4 to 36 months). The progression-free survival (PFS) at 1 and 2 years was 72% and 34% and the overall survival (OS) 76% and 50%, respectively. No severe toxicity was recorded. In univariate and multivariate analysis extent of resection at diagnosis significantly influenced PFS and OS (p < 0.01). Patients with smaller recurren tumor volume treated had better local control and survival. Indeed, the 2-year PFS was 40% (≤ 50 cm(3)) versus 11% (p=0.1) and the 2-year OS 56% versus 33% (> 50 cm(3)), respectively (p=0.26).

Conclusion: In our experience, HSRT could be a safe and feasible therapeutic option for recurrent high grade glioma even in patients with larger tumors. We believe that a multidisciplinary evaluation is mandatory to assure the best treatment for selected patients. Local treatment should also be considered as part of an integrated approach.

Keywords: Glioma; Radiosurgery; Retreatment.

Conflict of interest statement

L. Cozzi is Clinical Research Scientist at Humanitas Cancer Center and acts as Scientific Advisor at Varian Medical Systems AG (Cham, Switzerland).

Figures

Fig. 1.
Fig. 1.
Three views of the computed tomography scan showing the recurrence site (A-C) and dose distribution from the volumetric modulated arc therapy plan (D-F) for one patient.
Fig. 2.
Fig. 2.
Overall survival in high-grade glioma patients.
Fig. 3.
Fig. 3.
Progression-free survival in high-grade glioma patients.

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