Lucas Calduch Anna, Macià Garau Miquel, Villà Freixa Salvador, García Expósito Nagore, Modolell Farré Ignasi, Majós Torró Carles, Pons Escoda Albert, Mesía Barroso Carlos, Vilariño Quintela Noelia, Rosselló Gómez Aleix, Plans Ahicart Gerard, Martínez García María, Esteve Gómez Anna, Bruna Escuer Jordi
Radiation Oncology Service, Institut Català d'Oncologia (ICO)-Hospital Duran I Reynals, L'Hospitalet de Llobregat, Avda. Gran Via de L'Hospitalet 199-203, 08908, Barcelona, Spain.
Radiation Oncology, Institut Català de'Oncologia (ICO), Badalona, Barcelona, Spain.
Clin Transl Oncol. 2025 May;27(5):2104-2112. doi: 10.1007/s12094-024-03750-8. Epub 2024 Oct 10.
To assess the clinical outcome of patients with recurrent glioblastoma treated with salvage reirradiation.
Between 2005 and 2022, data from adult patients with glioblastoma treated with surgery and radio-chemotherapy Stupp regimen who developed a local in-field relapse and received stereotactic radiotherapy (SRT) were retrospectively reviewed.
The study population included 44 patients with recurrent glioblastoma (median of 9.5 months after the first radiotherapy). Reirradiation alone was given to 47.7% of patients. The median maximum diameter of the recurrence was 13.5 mm. The most common SRT regimen (52.3%) was 35 Gy in 10 fractions. Acute toxicity was mild, with transient worsening of previous neurological symptoms in only 15% of patients. After a median follow-up of 15 months, 40% presented radiological response, but a remarkable number of early distant progressions were recorded (32.5%). The median time to progression was 4.8 months, being the dose, the scheme, the size of the recurrence or the strategy (exclusive RT vs. combined) unrelated factors. The median overall survival (OS) was 14.9 months. Karnofsky index < 70 and the size of the recurrence (maximum diameter < 25 mm) were significant factors associated with OS. Radiological changes after reirradiation were commonly seen (> 50% of patients) hindering the response assessment.
Reirradiation is a feasible and safe therapeutic option to treat localized glioblastoma recurrences, able to control the disease for a few months in selected patients, especially those with good functional status and small lesions. Hypofractionated schemes provided a suitable toxicity profile. Radiological changes were common.
评估复发性胶质母细胞瘤患者接受挽救性再照射治疗的临床疗效。
回顾性分析2005年至2022年间，接受手术及放射化疗Stupp方案治疗后出现局部野内复发并接受立体定向放射治疗（SRT）的成年胶质母细胞瘤患者的数据。
研究人群包括44例复发性胶质母细胞瘤患者（首次放疗后中位时间为9.5个月）。47.7%的患者仅接受了再照射。复发灶的中位最大直径为13.5毫米。最常见的SRT方案（52.3%）是10次分割给予35 Gy。急性毒性较轻，仅15%的患者出现既往神经症状短暂加重。中位随访15个月后，40%出现影像学反应，但记录到相当数量的早期远处进展（32.5%）。中位进展时间为4.8个月，剂量、方案、复发灶大小或策略（单纯放疗与联合治疗）均为无关因素。中位总生存期（OS）为14.9个月。卡诺夫斯基指数<70以及复发灶大小（最大直径<25毫米）是与OS相关的重要因素。再照射后的影像学改变常见（>50%的患者），影响反应评估。
再照射是治疗局限性胶质母细胞瘤复发的一种可行且安全的治疗选择，能够在部分患者中控制疾病数月，尤其是功能状态良好且病灶较小的患者。低分割方案具有合适的毒性特征。影像学改变常见。
