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Hypofractionated Re-irradiation after Maximal Surgical Resection for Recurrent Glioblastoma: Therapeutic Adequacy and Its Prognosticators of Survival

Authors
 Jeongshim Lee  ;  Sung Soo Ahn  ;  Jong Hee Chang  ;  Chang Ok Suh 
Citation
 Yonsei Medical Journal, Vol.59(2) : 194-201, 2018 
Journal Title
 Yonsei Medical Journal 
ISSN
 0513-5796 
Issue Date
2018
MeSH
Adult ; Brain Neoplasms/mortality/pathology/*therapy ; Dose Hypofractionation ; Female ; Glioblastoma/mortality/pathology/*therapy ; Humans ; Karnofsky Performance Status ; Male ; Middle Aged ; Local/mortality/pathology/*therapy Neoplasm Recurrence ; Prognosis ; *Radiosurgery ; Re-Irradiation/*methods ; Salvage Therapy/methods ; Survival Rate ; Treatment Outcome
Keywords
Recurrent glioblastoma ; re-irradiation ; retreatment ; surgery ; survival
Abstract
PURPOSE: To evaluate the adequacy of retreatment, including hypofractionated re-irradiation (HFReRT), after surgery for recurrent glioblastoma (GBM) and related prognosticators of outcomes. MATERIALS AND METHODS: From 2011 to 2014, 25 consecutive patients with recurrent (n=17) or secondary (n=7) disease underwent maximal surgery and subsequent HFReRT after meeting the following conditions: 1) confirmation of recurrent or secondary GBM after salvage surgery; 2) Karnofsky performance score (KPS) >/=60; and 3) interval of >/=12 months between initial radiotherapy and HFReRT. HFReRT was delivered using a simultaneous integrated boost technique, with total dose of 45 Gy in 15 fractions to the gross tumor volume (GTV) and 37.5 Gy in 15 fractions to the clinical target volume. RESULTS: During a median follow-up of 13 months, the median progression-free and overall survival (OS) were 13 and 16 months, respectively. A better KPS (p=0.026), no involvement of the eloquent area at recurrence (p=0.030), and a smaller GTV (p=0.005) were associated with better OS. Additionally, OS differed significantly between risk groups stratified by the National Institutes of Health Recurrent GBM Scale (low-risk vs. high-risk, p=0.025). Radiologically suspected radiation necrosis (RN) was observed in 16 patients (64%) at a median of 9 months after HFReRT, and 8 patients developed grade 3 RN requiring hospitalization. CONCLUSION: HFReRT after maximal surgery prolonged survival in selected patients with recurrent GBM, especially those with small-sized recurrences in non-eloquent areas and good performance.
Files in This Item:
T201800418.pdf Download
DOI
10.3349/ymj.2018.59.2.194
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Suh, Chang Ok(서창옥)
Ahn, Sung Soo(안성수) ORCID logo https://orcid.org/0000-0002-0503-5558
Lee, Jeong Shim(이정심)
Chang, Jong Hee(장종희)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/161960
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