Purpose: Treatment approaches for high grade gliomas recurrences include second surgery, re-irradiation, systemic therapies and supportive cares. We retrospectively investigated the feasibility of a second irradiation with or without chemotherapy for patients with recurrence of high grade glioma.
Methods and Materials: Thirty patients with recurrence of high-grade gliomas received a median re-irradiation dose of 36 Gy (34 – 41.1 Gy) with conventional fractionation (1.8 – 2 Gy/die) at our institution. Median age at the recurrence was 53 years (range 21-75 years). Twelve patients received chemotherapy (Temozolomide) as concomitant and adjuvant treatment, 8 patients received reirradiation followed by adjuvant chemotherapy (Fotemustine), 10 patients received re-irradiation alone. Overall survival was calculated with Kaplan-Meier method. Neurocognitive evaluation (Mini-mental test and quality of life evaluation) was carried out with psycho-oncologist and patients underwent a neurocognitive rehabilitation therapy.
Results: Mean time between radiation therapies was 36 months (6-176 months). All patients carried out re-irradiation, with no cases of Grade ≥ 3 toxicity. At a follow up of 15 months, overall survival was 8 months (1-95 months). The group treated with concomitant chemo-radiotherapy shows a better overall survival compared with the group treated with only re-irradiation (16 vs. 7 months); 1 yearOS was 57.1% vs. 35.7% and 2 years-OS was 47.6% vs. 26.8%. From neurocognitive evaluation we report a good feasibility of re-irradiation, with good compliance to neurocognitive rehabilitation therapy.
Conclusion: In our experience, re-irradiation associated with chemotherapy (Temozolomide) for recurrent high grade gliomas represents a good treatment option, with better OS. Patients selection is important to identify those patients who benefit from this approach.
Angela Caroli, Lorenzo Vinante, Paola Chiovati, Maria Antonietta Annunziata, Roberto Bortolus, Martina Urbani, Tamara Ius, Miran Skrap and Mauro Arcicasa