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14.06.2017 | Original Article

Re-irradiation after gross total resection of recurrent glioblastoma

Spatial pattern of recurrence and a review of the literature as a basis for target volume definition

verfasst von: Dr. med. Christoph Straube, MD, Greeshma Elpula, M.Sc. MD, PD Dr. med. Jens Gempt, Dr. med. Julia Gerhardt, Dr. med. Stefanie Bette, Prof. Dr. med. Claus Zimmer, PD Dr. med. Friederike Schmidt-Graf, Prof. Dr. med. Bernhard Meyer, Prof. Dr. med. Stephanie E. Combs

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 11/2017

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Abstract

Background

Currently, patients with gross total resection (GTR) of recurrent glioblastoma (rGBM) undergo adjuvant chemotherapy or are followed up until progression. Re-irradiation, as one of the most effective treatments in macroscopic rGBM, is withheld in this situation, as uncertainties about the pattern of re-recurrence, the target volume, and also the efficacy of early re-irradiation after GTR exist.

Methods

Imaging and clinical data from 26 consecutive patients with GTR of rGBM were analyzed. The spatial pattern of recurrences was analyzed according to the RANO-HGG criteria (“response assessment in neuro-oncology criteria for high-grade gliomas”). Progression-free (PFS) and overall survival (OS) were analyzed by the Kaplan–Meier method. Furthermore, a systematic review was performed in PubMed.

Results

All but 4 patients underwent adjuvant chemotherapy after GTR. Progression was diagnosed in 20 of 26 patients and 70% of recurrent tumors occurred adjacent to the resection cavity. The median extension beyond the edge of the resection cavity was 20 mm. Median PFS was 6 months; OS was 12.8 months. We propose a target volume containing the resection cavity and every contrast enhancing lesion as the gross tumor volume (GTV), a spherical margin of 5–10 mm to generate the clinical target volume (CTV), and a margin of 1–3 mm to generate the planning target volume (PTV). Re-irradiation of this volume is deemed to be safe and likely to prolong PFS.

Conclusion

Re-irradiation is worth considering also after GTR, as the volumes that need to be treated are limited and re-irradiation has already proven to be a safe treatment option in general. The strategy of early re-irradiation is currently being tested within the GlioCave/NOA 17/Aro 2016/03 trial.

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Titel: Re-irradiation after gross total resection of recurrent glioblastoma
Spatial pattern of recurrence and a review of the literature as a basis for target volume definition
verfasst von: Dr. med. Christoph Straube, MD
Greeshma Elpula, M.Sc. MD
PD Dr. med. Jens Gempt
Dr. med. Julia Gerhardt
Dr. med. Stefanie Bette
Prof. Dr. med. Claus Zimmer
PD Dr. med. Friederike Schmidt-Graf
Prof. Dr. med. Bernhard Meyer
Prof. Dr. med. Stephanie E. Combs
Publikationsdatum: 14.06.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 11/2017
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-017-1161-6

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25.04.2024 | Nierenkarzinom | Nachrichten

Springer Medizin

Re-irradiation after gross total resection of recurrent glioblastoma

Spatial pattern of recurrence and a review of the literature as a basis for target volume definition

Abstract

Background

Methods

Results

Conclusion

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Springer Medizin

Abstract

Background

Methods

Results

Conclusion

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