Re-irradiation for recurrent high-grade glioma: an analysis of prognostic factors for survival and predictors of radiation necrosis (May, 10.1007/s11060-023-04340-4, 2023)

被引：1

作者：

Moore-Palhares, Daniel ^{[1
]}

Chen, Hanbo ^{[1
]}

Keith, Julia ^{[2
]}

Wang, Michael ^{[1
]}

Myrehaug, Sten ^{[1
]}

Tseng, Chia-Lin ^{[1
]}

Detsky, Jay ^{[1
]}

Perry, James ^{[3
]}

Lim-Fat, Mary Jane ^{[3
]}

Heyn, Chris ^{[4
]}

Maralani, Pejman ^{[4
]}

Lipsman, Nir ^{[5
]}

Das, Sunit ^{[6
]}

Sahgal, Arjun ^{[1
]}

Soliman, Hany ^{[1
]}

机构：

[1] Univ Toronto, Odette Canc Ctr, Sunnybrook Hlth Sci Ctr, Dept Radiat Oncol, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada

[2] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Lab Med & Mol Diagnost, Toronto, ON, Canada

[3] Univ Toronto, Sunnybrook Hlth Sci Ctr, Div Neurol, Dept Med, Toronto, ON, Canada

[4] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Med Imaging, Toronto, ON, Canada

[5] Univ Toronto, Sunnybrook Hlth Sci Ctr, Div Neurosurg, Toronto, ON, Canada

[6] Univ Toronto, St Michaels Hosp, Div Neurosurg, Toronto, ON, Canada

来源：

JOURNAL OF NEURO-ONCOLOGY | 2023年 / 163卷 / 03期

关键词：

Corticosteroid dependence; Glioblastoma; Pattern of failure; Radiation necrosis; Re-irradiation; Recurrent high-grade glioma;

D O I：

10.1007/s11060-023-04364-w

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Purpose: Recurrent high-grade glioma (rHGG) is a heterogeneous population, and the ideal patient selection for re-irradiation (re-RT) has yet to be established. This study aims to identify prognostic factors for rHGG patients treated with re-RT. Methods: We retrospectively reviewed consecutive adults with rHGG who underwent re-RT from 2009 to 2020 from our institutional database. The primary objective was overall survival (OS). Secondary endpoints included prognostic factors for early death (< 6 months after re-RT) and predictors of radiation necrosis (RN). Results: For the 79 patients identified, the median OS after re-RT was 9.9 months (95% CI 8.3–11.6). On multivariate analyses, re-resection at progression (HR 0.56, p = 0.027), interval from primary treatment to first progression ≥ 16.3 months (HR 0.61, p = 0.034), interval from primary treatment to re-RT ≥ 23.9 months (HR 0.35, p < 0.001), and re-RT PTV volume < 112 cc (HR 0.27, p < 0.001) were prognostic for improved OS. Patients who had unmethylated-MGMT tumours (OR 12.4, p = 0.034), ≥ 3 prior systemic treatment lines (OR 29.1, p = 0.022), interval to re-RT < 23.9 months (OR 9.0, p = 0.039), and re-RT PTV volume ≥ 112 cc (OR 17.8, p = 0.003) were more likely to die within 6 months of re-RT. The cumulative incidence of RN was 11.4% (95% CI 4.3–18.5) at 12 months. Concurrent bevacizumab use (HR < 0.001, p < 0.001) and cumulative equivalent dose in 2 Gy fractions (EQD2, α/β = 2) < 99 Gy2 (HR < 0.001, p < 0.001) were independent protective factors against RN. Re-RT allowed for less corticosteroid dependency. Sixty-six percent of failures after re-RT were in-field. Conclusion: We observe favorable OS rates following re-RT and identified prognostic factors, including methylation status, that can assist in patient selection and clinical trial design. Concurrent use of bevacizumab mitigated the risk of RN. © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

引用

页码：553 / 553

页数：1