Dejonckheere Cas S, Zeyen Thomas, Duffy Cathrina, Layer Yannik C, Potthoff Anna-Laura, Wichtmann Barbara D, Friker Lea L, Scafa Davide, Leitzen Christina, Nour Younèss, Kugel Fabian, Schäfer Niklas, Radbruch Alexander, Vatter Hartmut, Grosu Anca-Ligia, Herrlinger Ulrich, Schneider Matthias, Giordano Frank A, Sarria Gustavo R, Gkika Eleni, Layer Julian P
Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany.
Department of Neurooncology, Center for Neurology and Integrated Oncology (CIO), University Hospital Bonn, Bonn, Germany.
Clin Transl Radiat Oncol. 2025 Aug 8;55:101029. doi: 10.1016/j.ctro.2025.101029. eCollection 2025 Nov.
The management of recurrent glioblastoma (rGBM) remains a clinical challenge, with only limited therapeutic options available to date. Reirradiation may offer a progression-free survival (PFS) benefit in selected cases, but data are scarce.
Consecutive patients from the last 10 years with GBM (CNS WHO grade 4, IDH-wildtype) who underwent at least one additional course of cranial radiotherapy for suspected or histopathologically confirmed rGBM at a tertiary neuro-oncological center were retrospectively analyzed. The primary endpoint was PFS, secondary endpoints included reirradiation-related adverse event rates, with a particular focus on radiation necrosis (RN).
Fifty-nine patients were included with a median follow-up (range) of 8.7 (0.5-48.0) months after reirradiation. The median time to first recurrence was 15 (4-89) months, with the majority occurring in-field (59.7 %). The EQD2 ranged from 31.3-80.2 Gy with a median prescription dose of 42 Gy. Reirradiation was combined with systemic therapy in 81.4 % of patients. No grade 3-5 acute reirradiation-related adverse events were observed. RN was diagnosed in 16.9 % of patients (80 % grade 2 and 20 % grade 3), with a notably low rate in those receiving anti-VEGF therapy parallel to reirradiation. RN risk was independent of reirradiation volume or dose ( = 0.15 and 0.43, respectively). The disease control rate following reirradiation was 83.6 % and the median PFS was 5.9 (0.5-48.0) months. Concomitant chemotherapy or anti-VEGF therapy was significantly associated with improved outcomes ( = 0.049), whereas smaller reirradiation volumes demonstrated a non-significant trend towards longer PFS ( = 0.23).
In this retrospective analysis, reirradiation for rGBM was feasible and safe, conferring a potential PFS benefit in selected patients. Bevacizumab emerged as a particularly promising combination partner, contributing to both RN prevention and enhanced efficacy.
复发性胶质母细胞瘤（rGBM）的治疗仍然是一项临床挑战，迄今为止可用的治疗选择有限。再次放疗在某些情况下可能会带来无进展生存期（PFS）获益，但相关数据较少。
回顾性分析了过去10年在一家三级神经肿瘤中心因疑似或组织病理学确诊的rGBM而接受至少一个额外疗程颅脑放疗的连续胶质母细胞瘤患者（CNS WHO 4级，异柠檬酸脱氢酶野生型）。主要终点是PFS，次要终点包括再次放疗相关不良事件发生率，特别关注放射性坏死（RN）。
纳入59例患者，再次放疗后的中位随访时间（范围）为8.7（0.5 - 48.0）个月。首次复发的中位时间为15（4 - 89）个月，大多数复发发生在照射野内（59.7%）。等效剂量2（EQD2）范围为31.3 - 80.2 Gy，中位处方剂量为42 Gy。81.4%的患者再次放疗与全身治疗联合使用。未观察到3 - 5级急性再次放疗相关不良事件。16.9%的患者被诊断为RN（80%为2级，20%为3级），在与再次放疗同时接受抗血管内皮生长因子（VEGF）治疗的患者中发生率显著较低。RN风险与再次放疗体积或剂量无关（分别为0.15和0.43）。再次放疗后的疾病控制率为83.6%，中位PFS为5.9（0.5 - 48.0）个月。同步化疗或抗VEGF治疗与改善结局显著相关（P = 0.049），而较小的再次放疗体积显示出PFS延长的非显著趋势（P = 0.23）。
在这项回顾性分析中，rGBM的再次放疗是可行且安全的，在部分患者中可带来潜在的PFS获益。贝伐单抗是一种特别有前景的联合治疗药物，有助于预防RN并提高疗效。
