Reirradiation in recurrent glioblastoma

Reirradiation has emerged as a potentially valuable treatment strategy for recurrent glioblastoma, a disease characterized by inevitable local progression despite aggressive multimodal first-line therapy. Recent advances in radiotherapy techniques, improved patient selection, and evolving systemic treatment combinations have renewed clinical interest in this approach. This is reflected by recent publication of the first international consensus guidelines (ESTRO/EANO) and the initiation of an European phase III randomized trial on reirradiation of patients with recurrent glioblastoma.

Retrospective and early-phase prospective studies have demonstrated that reirradiation is feasible and well tolerated in selected patients, with median overall survival ranging from 7 to 13 months. The ESTRO/EANO guidelines on reirradiation of glioma provide standardized recommendations for patient selection, dose constraints, and target volume delineation. Meta-analyses suggest improved outcomes when reirradiation is combined with systemic therapies, such as bevacizumab or lomustine. The phase III EORTC-2227-BTG (LEGATO) trial will provide definitive data on survival benefit.

Reirradiation is gaining acceptance as a palliative yet potentially impactful treatment for recurrent glioblastoma. While current evidence supports its use in selected cases, results from ongoing phase III LEGATO trial will determine its future role in standard care and inform evidence-based clinical decision-making.