González Mercedes López, Ciervide Raquel, Requejo Ovidio Hernando, Luis Ángel Montero, Rodriguez Beatriz Álvarez, Saugar Emilio Sánchez, Iracheta Leyre Alonso, Chen Xin, Garcia-Aranda Mariola, Zucca Daniel, Valero Jeannette, Alonso Rosa, Fernández-Letón Pedro, Rubio Carmen
Department of Radiation Oncology, HM Hospitales, Madrid, Spain.
Department of Medical Physics, HM Hospitales, Madrid, Spain.
Rep Pract Oncol Radiother. 2024 Dec 4;29(5):566-578. doi: 10.5603/rpor.102820. eCollection 2024.
Recurrent high-grade gliomas present a therapeutic challenge. Repeat surgery, re-irradiation, and systemic therapy have been explored, with re-irradiation requiring precise tumor relapse delineation and advanced dosimetric techniques. This study aims to evaluate the effectiveness and tolerability of re-irradiation using Hypofractionated Stereotactic Radiation (HFSRT) schedules.
In a retrospective analysis from 2011 to 2021, 52 adult patients with recurrent high-grade gliomas were examined, including 42.3% with glioblastoma, 32.5% with grade 3 gliomas, and 25% with grade 2 gliomas as initial diagnosis. All received prior radiotherapy at doses ranging from 54-60 Gy, with a median time to tumor relapse of 19.8 months. Salvage surgery was performed in 42.3% of cases, with a median interval of 22.45 months between radiation courses. Re-irradiation doses were 30 Gy in 5 fractions for 54% and 40 Gy in 10 fractions for 46%. Concurrent systemic treatments included temozolomide (30.8%), nevacizumab (27%), or none (35%).
In-field and out-field tumor progression occurred in 65.4% and 25% of patients, with median times to local and distant progression of 5.17 and 4.57 months. Median overall survival (OS) from re-irradiation was 12 months. Univariate analysis showed a trend favoring 30 Gy in 5 fractions for disease progression-free survival (DPFS). Treatment was generally well-tolerated, with only 5.7% experiencing acute Grade-3 toxicity, and symptomatic radionecrosis occurred in 2 patients.
Re-irradiation using HFSRT for recurrent high-grade gliomas is viable and well-tolerated, demonstrating survival rates comparable to existing literature. These findings underscore the potential of HFSRT in managing recurrent high-grade gliomas.
复发性高级别胶质瘤带来了治疗挑战。人们已探索了重复手术、再程放疗和全身治疗，其中再程放疗需要精确描绘肿瘤复发情况并采用先进的剂量测定技术。本研究旨在评估使用低分割立体定向放射治疗（HFSRT）方案进行再程放疗的有效性和耐受性。
在一项2011年至2021年的回顾性分析中，对52例复发性高级别胶质瘤成年患者进行了检查，其中42.3%最初诊断为胶质母细胞瘤，32.5%为3级胶质瘤，25%为2级胶质瘤。所有患者之前均接受过54 - 60 Gy的放疗，肿瘤复发的中位时间为19.8个月。42.3%的病例进行了挽救性手术，放疗疗程之间的中位间隔为22.45个月。54%的患者再程放疗剂量为30 Gy分5次，46%的患者为40 Gy分10次。同步全身治疗包括替莫唑胺（30.8%）、贝伐单抗（27%）或不进行（35%）。
65.4%和25%的患者分别出现野内和野外肿瘤进展，局部和远处进展的中位时间分别为5.17个月和4.57个月。再程放疗后的中位总生存期（OS）为12个月。单因素分析显示，对于无疾病进展生存期（DPFS），倾向于30 Gy分5次的趋势。治疗总体耐受性良好，只有5.7%的患者出现3级急性毒性，2例患者出现症状性放射性坏死。
使用HFSRT对复发性高级别胶质瘤进行再程放疗是可行的且耐受性良好，生存率与现有文献相当。这些发现强调了HFSRT在治疗复发性高级别胶质瘤方面的潜力。
