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Re-irradiation in the Brain: Primary Gliomas
1Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK.
Clinical Oncology (Royal College of Radiologists (Great Britain))
|January 4, 2018
Summary
Re-irradiation for recurrent gliomas is a viable treatment option when using the Combs prognostic score to select patients. Limiting the cumulative dose to 100 Gy (NTDcumulative) ensures an acceptable safety profile, reducing radionecrosis risks.
Area of Science:
- Neuro-oncology
- Radiation Oncology
- Clinical Neurology
Background:
- Recurrent gliomas present significant treatment challenges.
- Historically, re-irradiation has been approached cautiously due to toxicity concerns, particularly radionecrosis.
- Evidence for re-irradiation is primarily from single-institution case series.
Purpose of the Study:
- To review the evidence supporting re-irradiation for recurrent gliomas.
- To outline the development and application of the Combs prognostic score.
- To provide recommendations for optimizing re-irradiation strategies.
Main Methods:
- Review of published literature on re-irradiation for gliomas.
- Analysis of data from fractionated radiotherapy and stereotactic radiosurgery series.
- Examination of the Combs prognostic score's role in patient selection.
Main Results:
- Re-irradiation demonstrates an acceptable safety profile when the cumulative dose (NTDcumulative) is limited to 100 Gy.
- Bevacizumab, used with re-irradiation, appears well-tolerated and may mitigate radionecrosis.
- The Combs prognostic score aids in identifying suitable candidates for re-irradiation.
Conclusions:
- The Combs prognostic score is crucial for selecting appropriate patients for re-irradiation.
- Re-irradiation should be more widely adopted with modern precision radiotherapy techniques.
- Fractionated radiotherapy or stereotactic radiosurgery can be used based on tumor characteristics, up to a maximum NTDcumulative of 100 Gy.
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