Re-irradiation for recurrent high grade glioma (HGG) patients: Results of a single arm prospective phase 2 study.

Abstract

BACKGROUND AND PURPOSE:

Standard of care for recurrent high grade glioma (HGG) is missing. Several treatment options have been investigated including re-irradiation (re-RT). Results are promising but provided by retrospective studies. We designed a single arm prospective phase II study aiming to evaluate efficacy, and toxicity of re-irradiation.

MATERIALS AND METHODS:

Adults patients with good performance status, HGG diagnosis reclassified according to the new 2021 fifth edition WHO CNS classification, an interval time (IT) from previous RT ≥ 6 months were included. Outcome was evaluated by MRI imaging at 1 month, and every 3 months thereafter. Toxicities were evaluated in terms of radionecrosis occurrence, and neurocognitive status.

RESULTS:

Ninety recurrent HGG patients were treated, 11 oligodendroglioma grade 3, 18 astrocytoma grade 3 and 4, and 61 glioblastoma grade 4. The median age was 54 years, and majority had KPS 90-100. The median IT between first-RT and re-RT was 24 months. Re-surgery has been performed in 56.6%, and chemotherapy in 53.3%. The median follow up time was 64 months; median overall survival (OS) time,1,2,3-year OS rates were 17 months (95%CI 14-19), 66.7%±4.9, 32.6%±5.0, and 22.2 ± 4.7. Prognostic factors impacting on survival were age (p = 0.0154), IT between first RT and re-RT (p = 0.0051), glioma grade (p = 0.0090), and IDH status (p = 0.0001). Radionecrosis grade 2-3 occurred in 9 (10%) patients; neurocognitive functions remained stable until disease progression.

CONCLUSION:

Re-RT proved to be a safe and feasible treatment option with low toxicity. Younger patients with grade 3 IDH mutated gliomas, and a longer IT had the better outcome.

TRIAL REGISTRATION NUMBER:

NCT02567539.

• Authors: Pierina Navarria, Federico Pessina, Elena Clerici, Luisa Bellu, Ciro Franzese, Andrea Franzini, Matteo Simonelli, Lorenzo Bello, Armando Santoro, Letterio Salvatore Politi, Giuseppe Roberto D'agostino, Alessandra Casarotti, Bethania Fernandes, Valter Torri, Marta Scorsetti
• Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (Radiother Oncol) Vol. 167 Pg. 89-96 (02 2022) ISSN: 1879-0887 [Electronic] Ireland
• PMID: 34952000 (Publication Type: Clinical Trial, Phase II, Journal Article)
• Copyright: Published by Elsevier B.V.

Topics

• Adult
• Brain Neoplasms (drug therapy)
• Glioma (therapy)
• Humans
• Middle Aged
• Neoplasm Recurrence, Local
• Prospective Studies
• Radiation Injuries
• Re-Irradiation (adverse effects)
• Retrospective Studies