Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India.
Department of Neuro-Surgical Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India.
Clin Transl Oncol. 2021 Jul;23(7):1358-1367. doi: 10.1007/s12094-020-02526-0. Epub 2021 Feb 2.
To report survival outcomes and identify prognostic factors of salvage re-irradiation (re-RT) in recurrent/progressive glioma.
Medical records of patients treated with high-dose re-RT as part of multi-modality salvage therapy for recurrence/progression of adult diffuse glioma from 2010 to 2019 were analyzed retrospectively.
A total of 111 patients developing recurrent/progressive high-grade glioma after adequate upfront treatment at initial diagnosis were included. The first course of radiotherapy (RT) had been delivered to a median dose of 59.4 Gy with an inter-quartile range (IQR) of 54-60 Gy. Median time to recurrence/progression was 4.3 years (IQR = 2.3-7.4 years) while the median time to re-RT was 4.8 years (IQR = 3.6-7.9 years). Re-RT was delivered with intensity-modulated radiation therapy (IMRT) using 1.8 Gy/fraction to a median dose of 54 Gy (IQR = 50.4-55.8 Gy) for a cumulative median equivalent dose in 2-Gy fractions (EQD2) of 104.3 Gy (IQR = 102.6-109.4 Gy). At a median follow-up of 14 months after re-RT, the 1-year Kaplan-Meier estimates of post-re-RT progression-free survival (PFS) and overall survival (OS) were 42.8 and 61.8%, respectively. Univariate analysis identified histological grade at recurrence/progression; histological subtype; disease-free interval (DFI) and time interval between both courses of RT; performance status at re-RT; dose at re-RT and cumulative EQD2; isocitrate dehydrogenase (IDH) mutation; and O-methyl-guanine DNA methyl transferase (MGMT) gene promoter methylation as significant prognostic factors. Preserved performance status, longer DFI, prolonged time interval between both courses of RT, and presence of IDH mutation were associated with significantly improved PFS on multi-variate analysis. However, only performance status retained independent prognostic significance for OS on multi-variate analysis. Post-treatment changes were seen in 33 (30%) patients on follow-up imaging, with higher cumulative dose (EQD2 ≥ 104.3 Gy) being associated with increased risk of post-re-RT pseudo-progression.
This clinical audit reports encouraging survival outcomes and identifies key prognostic factors associated with high-dose salvage re-RT in recurrent/progressive glioma.
报告挽救性再放疗（re-RT）治疗复发性/进展性胶质瘤的生存结果，并确定其预后因素。
回顾性分析了 2010 年至 2019 年期间，因成人弥漫性胶质瘤复发/进展而接受高剂量挽救性再放疗（re-RT）联合多模态挽救治疗的患者的病历。
共纳入 111 例初诊时接受充分初始治疗后发生复发性/进行性高级别胶质瘤的患者。首次放疗（RT）中位剂量为 59.4 Gy，四分位间距（IQR）为 54-60 Gy。中位复发/进展时间为 4.3 年（IQR=2.3-7.4 年），中位 re-RT 时间为 4.8 年（IQR=3.6-7.9 年）。挽救性再放疗采用 1.8 Gy/次分割，中位剂量为 54 Gy（IQR=50.4-55.8 Gy），2-Gy 等效剂量累积中位数为 104.3 Gy（IQR=102.6-109.4 Gy）。再放疗后中位随访 14 个月时，再放疗后 1 年的无进展生存（PFS）和总生存（OS）的 Kaplan-Meier 估计值分别为 42.8%和 61.8%。单因素分析显示，再复发/进展时的组织学分级；组织学亚型；无疾病间隔（DFI）和两次 RT 之间的时间间隔；再放疗时的表现状态；再放疗剂量和累积等效剂量 2（EQD2）；异柠檬酸脱氢酶（IDH）突变；O-甲基鸟嘌呤 DNA 甲基转移酶（MGMT）基因启动子甲基化是显著的预后因素。多变量分析显示，保持良好的表现状态、较长的 DFI、两次 RT 之间的时间间隔延长以及 IDH 突变与显著改善的 PFS 相关。然而，只有表现状态在多变量分析中对 OS 具有独立的预后意义。在随访影像学检查中，33 例（30%）患者出现治疗后变化，累积剂量较高（EQD2≥104.3 Gy）与再放疗后假性进展风险增加相关。
本临床审计报告显示，挽救性高剂量再放疗治疗复发性/进展性胶质瘤具有令人鼓舞的生存结果，并确定了与该治疗相关的关键预后因素。
