Review of Recurrent Glioma Patients Treated with Reirradiation and Chemotherapy
Background: Surgical resection followed by radiotherapy with temozolomide for patients with newly diagnosed Glioblastoma Multiforme (GBM) has shown a significant prolongation of survival and is now the standard of care. However, at present, no standard of treatment has been defined for recurrence. The late cumulative toxicity in the healthy brain tissue limiting the use of re-irradiation, as well as the feasibility of repeat course of temozolomide and the use of the newer targeted therapies (e.g. EGFR and VEGF inhibitors) are some of the controversial issues in the management for recurrent gliomas.
Objective(s): To determine the progression-free survival (PFS), overall survival (OS) and Karnofsky Performance Status (KPS) after reirradiation, the OS from diagnosis and incidence of radiation-induced late adverse effect among patients with recurrent glioma treated with reirradiation and concurrent chemotherapy.
Methods: Patients diagnosed with recurrent glioma from January 2005 to December 2010 who underwent brain reirradiation were included. External beam radiation therapy for the primary and recurrent lesion was usually delivered via Intensity Modulated Radiation Therapy (IMRT). The median dose given was 93.4 Gy (75.6 Gy – 130.6 Gy). All patients received concomitant therapy either with temozolomide and/or nimotuzumab. The following data were collected: (1) time to relapse period; (2) relapse clinical and/or radiologic findings; (3) treatment for relapse; (4) PFS at 6 months and 12 months from reirradiation; (5) KPS after reirradiation (6) OS rate and: (7) incidence of radiation-induced late adverse effect. Continuous data were summarized with medians and ranges.
Results: A total of 12 patients were evaluated. Eight had recurrent Glioblastoma Multiforme (GBM) while 4 had recurrent gliomas other than GBM. Our data shows that in patients with recurrent GBM the median OS from reirradiation is 27.5 months (5 -84 months) and the median OS is 45.5 months (9-144 months) and the PFS at 6 and 12 months after reirradiation is 62.5% and 50% respectively. While for patients with recurrent glioma other than GBM the median OS from reirradiation is 17.5 months (7-22 months), the median OS from diagnosis is 83.75 months (51-120 months) and the PFS at 6 and 12 months after reirradiation is 75% and 25% respectively. The KPS was maintained in the majority of patients after retreatment. Radiation- induced late adverse effect was seen in only one patient who developed cognitive changes 2 years after reirradiation.
Conclusion: Reirradiation with the addition of chemotherapy appears to be a viable and safe treatment option for recurrent gliomas. Our preliminary results show a longer PFS and OS as compared with other studies that also use reirradiation for this group of patients.