TY - JOUR
T1 - Re-resection for recurrent high-grade glioma in the setting of re-irradiation
T2 - more is not always better
AU - Palmer, Joshua D.
AU - Siglin, Joshua
AU - Yamoah, Kosj
AU - Dan, Tu
AU - Champ, Colin E.
AU - Bar-Ad, Voichita
AU - Werner-Wasik, Maria
AU - Evans, James J.
AU - Kim, Lyndon
AU - Glass, Jon
AU - Farrell, Christopher
AU - Andrews, David W.
AU - Shi, Wenyin
N1 - Publisher Copyright:
© 2015, Springer Science+Business Media New York.
PY - 2015/9/29
Y1 - 2015/9/29
N2 - The optimal treatment for patients with recurrent high grade glioma (HGG) remains controversial. Available therapies include surgery, re-irradiation, alternating electric fields or systemic therapy. Here we investigate whether re-resection will improve survival in patients receiving repeat radiotherapy for tumor recurrence. 231 consecutive patients with recurrent HGG treated with re-irradiation between 1994 and 2012 were analyzed. 105 patients underwent re-resection. Re-irradiation was delivered using daily fractions of 3.5 Gy to a median total dose of 35 Gy. Survival was then analyzed comparing patients with and without re-resection. Overall survival (OS) and survival from the first recurrence are reported. Univariate and cox-proportional hazard modeling was performed in a step-wise multivariate analysis using known prognostic factors. The median follow-up time from initial diagnosis was 25.7 months. The median OS from initial diagnosis of the entire group was 22.5 months. There was no significant difference in median overall survival between patients who received re-resection versus no re-resection, 23 versus 21.9 months respectively (p = 0.6). Additionally, there was no difference in median survival from the time of first recurrence 10.5 months without re-resection versus 11.1 months with re-resection (p = 0.09). After adjusting for known prognostic variables, only age remained significant. Re-irradiation is an effective salvage therapy for patients with localized, progressive high grade glioma, achieving a median survival of 10–11 months from re-irradiation. Our data reveals no significant improvement in survival with the addition of re-resection to re-irradiated patients with HGG.
AB - The optimal treatment for patients with recurrent high grade glioma (HGG) remains controversial. Available therapies include surgery, re-irradiation, alternating electric fields or systemic therapy. Here we investigate whether re-resection will improve survival in patients receiving repeat radiotherapy for tumor recurrence. 231 consecutive patients with recurrent HGG treated with re-irradiation between 1994 and 2012 were analyzed. 105 patients underwent re-resection. Re-irradiation was delivered using daily fractions of 3.5 Gy to a median total dose of 35 Gy. Survival was then analyzed comparing patients with and without re-resection. Overall survival (OS) and survival from the first recurrence are reported. Univariate and cox-proportional hazard modeling was performed in a step-wise multivariate analysis using known prognostic factors. The median follow-up time from initial diagnosis was 25.7 months. The median OS from initial diagnosis of the entire group was 22.5 months. There was no significant difference in median overall survival between patients who received re-resection versus no re-resection, 23 versus 21.9 months respectively (p = 0.6). Additionally, there was no difference in median survival from the time of first recurrence 10.5 months without re-resection versus 11.1 months with re-resection (p = 0.09). After adjusting for known prognostic variables, only age remained significant. Re-irradiation is an effective salvage therapy for patients with localized, progressive high grade glioma, achieving a median survival of 10–11 months from re-irradiation. Our data reveals no significant improvement in survival with the addition of re-resection to re-irradiated patients with HGG.
KW - Fractionated stereotactic radiotherapy
KW - Overall survival
KW - Re-resection
KW - Recurrent high-grade glioma
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U2 - 10.1007/s11060-015-1825-y
DO - 10.1007/s11060-015-1825-y
M3 - Article
C2 - 26024653
AN - SCOPUS:84942500077
SN - 0167-594X
VL - 124
SP - 215
EP - 221
JO - Journal of Neuro-Oncology
JF - Journal of Neuro-Oncology
IS - 2
ER -