Radiation Oncology Center Mittelland, Kantonsspital Aarau, Aarau, Switzerland.
Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland.
BMC Neurol. 2024 Nov 26;24(1):462. doi: 10.1186/s12883-024-03954-z.
90% of glioblastomas (GBM) relapse within two years of diagnosis. In contrast to the initial setting, there is no standard management for recurrent disease and options include hypofractionated stereotactic re-irradiation (re-mHSRT). The aims of this study were to investigate re-mHSRT practice in Swiss neuro-oncology centres.
A survey of 18 questions regarding re-irradiation for GBM was created and distributed electronically (SurveyMonkey, USA) to 11 radiation oncologists in Switzerland specialising in brain tumours. We evaluated the clinical outcomes of a multicentre series of patients treated with an established re-mHSRT schedule to benchmark these against the literature and investigated the radiological patterns of relapse after re-mHSRT.
8 of 11 (73%) radiation oncologists responded to the survey and re-irradiation practice was heterogeneous. The 10 × 3.5 Gy schedule (RTOG 1205, BRIOChe trials) was used by 5/8 respondents and 47/50 patients with recurrent GBM treated with re-mHSRT with this schedule in daily practice were included in the analysis. The median time to re-mHSRT following completion of adjuvant RT was 23.3 (7-224) months. The median PTV at re-mHSRT was 22.0 cm (0.9-190). Combined CTV + PTV margins ranged from 0 to 10 mm and median prescription isodose was 80% (67-100). 14/47 (30%) patients received temozolomide and four (8.5%) continued bevacizumab concomitantly. On multivariable analysis, concomitant systemic therapy predicted for progression-free survival (PFS), HR 2.87 (95% CI 1-03-7.96), p = 0.042. Median PFS following re-mHSRT was 6.6 (0.2-92.5) months and 26/47 patients (55%) received subsequent systemic therapy. The median overall survival (OS) following recurrence was 11.8 months (1.5-92.5), similar to the 10.8 months in the literature with the same schedule. The six-month OS rate was 37/47 (79%), which compares well with the 73% reported in a meta-analysis of 50 publications employing various schedules. In a subgroup analysis of 36/47 (79%) patients with MR follow-up after re-mHSRT, 8/36 (22%) had no radiological evidence of tumour progression at a median follow-up of 9.4 months. 21/28 (75%) radiological relapses were in-field, two were marginal and five were out of field.
Re-mHSRT with 10 × 3.5 Gy can achieve local control in selected patients with recurrent GBM.
90%的胶质母细胞瘤（GBM）在诊断后两年内复发。与初始治疗相比，复发性疾病尚无标准治疗方法，可选择的方法包括分次立体定向再放疗（re-mHSRT）。本研究旨在调查瑞士神经肿瘤学中心的 re-mHSRT 实践。
我们创建了一份关于 GBM 再放疗的 18 个问题的调查，并通过电子邮件（SurveyMonkey，美国）分发给瑞士 11 名专门从事脑肿瘤的放射肿瘤学家。我们评估了多中心系列患者接受既定 re-mHSRT 方案治疗的临床结果，将其与文献进行基准比较，并研究了 re-mHSRT 后复发的放射学模式。
11 名放射肿瘤学家中有 8 名（73%）回应了调查，再放疗实践存在异质性。5/8 名受访者使用了 10×3.5 Gy 方案（RTOG 1205、BRIOChe 试验），在日常实践中，有 47/50 名接受 re-mHSRT 治疗的复发性 GBM 患者接受了该方案治疗，并纳入分析。辅助放疗后接受 re-mHSRT 的中位时间为 23.3（7-224）个月。再放疗时的 PTV 中位数为 22.0cm（0.9-190）。CTV+PTV 综合边界范围为 0 至 10mm，中位处方等剂量为 80%（67-100）。14/47（30%）名患者接受替莫唑胺治疗，4 名（8.5%）同时继续贝伐单抗治疗。多变量分析显示，同时进行系统治疗可预测无进展生存期（PFS），HR 2.87（95%CI 1-03-7.96），p=0.042。再放疗后中位 PFS 为 6.6（0.2-92.5）个月，有 26/47 名（55%）患者接受了后续系统治疗。复发后的中位总生存期（OS）为 11.8 个月（1.5-92.5），与文献中使用相同方案的 10.8 个月相似。6 个月的 OS 率为 37/47（79%），与 50 篇文献的荟萃分析中报告的 73%相吻合，该荟萃分析采用了各种方案。在 re-mHSRT 后接受 MRI 随访的 36/47（79%）名患者的亚组分析中，在中位随访 9.4 个月时，8/36（22%）名患者无肿瘤进展的放射学证据。21/28（75%）的放射学复发为瘤内，2 例为边缘性，5 例为瘤外。
在选择的复发性 GBM 患者中，10×3.5 Gy 的 re-mHSRT 可实现局部控制。
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