Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, 81675, Munich, Germany.
Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.
Curr Treat Options Oncol. 2019 Jul 19;20(9):71. doi: 10.1007/s11864-019-0673-y.
The treatment of malignant gliomas has undergone a significant intensification during the past decade, and the interdisciplinary treatment team has learned that all treatment opportunities, including surgery and radiotherapy (RT), also have a central role in recurrent gliomas. Throughout the decades, re-irradiation (re-RT) has achieved a prominent place in the treatment of recurrent gliomas. A solid body of evidence supports the safety and efficacy of re-RT, especially when modern techniques are used, and justifies the early use of this regimen, especially in the case when macroscopic disease is present. Additionally, a second adjuvant re-RT to the resection cavity is currently being investigated by several investigators and seems to offer promising results. Although advanced RT technologies, such as stereotactic radiosurgery (SRS), fractionated stereotactic radiotherapy (FSRT), intensity-modulated radiotherapy (IMRT), and image-guided radiotherapy (IGRT) have become available in many centers, re-RT should continue to be kept in experienced hands so that they can select the optimal regimen, the ideal treatment volume, and the appropriate techniques from their tool-boxes. Concomitant or adjuvant use of systemic treatment options should also strongly be taken into consideration, especially because temozolomide (TMZ), cyclohexyl-nitroso-urea (CCNU), and bevacizumab have shown a good safety profile; they should be considered, if available. Nonetheless, the selection of patients for re-RT remains crucial. Single factors, such as patient age or the progression-free interval (PFI), fall too short. Therefore, powerful prognostic scores have been generated and validated, and these scores should be used for patient selection and counseling.
在过去的十年中，恶性胶质瘤的治疗已经得到了显著的强化，多学科治疗团队已经了解到，包括手术和放疗（RT）在内的所有治疗机会在复发性神经胶质瘤中也具有核心作用。几十年来，再放疗（re-RT）在复发性神经胶质瘤的治疗中占据了重要地位。大量证据支持 re-RT 的安全性和有效性，尤其是在使用现代技术时，并且证明了早期使用这种方案的合理性，尤其是在存在宏观疾病的情况下。此外，目前有几位研究人员正在研究对切除腔进行第二次辅助 re-RT，这似乎提供了有希望的结果。尽管许多中心都提供了先进的 RT 技术，如立体定向放射外科（SRS）、分次立体定向放射治疗（FSRT）、强度调制放射治疗（IMRT）和图像引导放射治疗（IGRT），但 re-RT 仍应继续由经验丰富的医生进行，以便他们能够从自己的工具包中选择最佳方案、理想的治疗体积和适当的技术。同时还应强烈考虑系统治疗选择的联合或辅助使用，特别是因为替莫唑胺（TMZ）、环己基亚硝脲（CCNU）和贝伐单抗显示出良好的安全性；如果可用，应考虑使用这些药物。尽管如此，对 re-RT 的患者选择仍然至关重要。单一因素，如患者年龄或无进展生存期（PFI），显得过于简单。因此，已经生成和验证了强大的预后评分，并且应该使用这些评分来进行患者选择和咨询。
