Re-irradiation for recurrent glioma: outcome evaluation, toxicity and prognostic factors assessment. A multicenter study of the Radiation Oncology Italian Association (AIRO)

Pierina Navarria, Giuseppe Minniti, Elena Clerici, Stefano Tomatis, Valentina Pinzi, Patrizia Ciammella, Marco Galaverni, Dante Amelio, Daniele Scartoni, Silvia Scoccianti, Marco Krengli, Laura Masini, Lorena Draghini, Ernesto Maranzano, Valentina Borzillo, Paolo Muto, Fabio Ferrarese, Laura Fariselli, Lorenzo Livi, Francesco PasqualettiAlba Fiorentino, Filippo Alongi, Michela Buglione di Monale, Stefano Magrini, Marta Scorsetti

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: The prognosis of glioma is dismal, and almost all patients relapsed. At recurrence time, several treatment options are considered, but to date there is no a standard of care. The Neurooncology Study Group of the Italian Association of Radiation Oncology (AIRO) collected clinical data regarding a large series of recurrent glioma patients who underwent re-irradiation (re-RT) in Italy.

METHODS: Data regarding 300 recurrent glioma patients treated from May 2002 to November 2017, were analyzed. All patients underwent re-RT. Surgical resection, followed by re-RT with concomitant and adjuvant chemotherapy was performed. Clinical outcome was evaluated by neurological examination and brain MRI performed, 1 month after radiation therapy and then every 3 months.

RESULTS: Re-irradiation was performed at a median interval time (IT) of 16 months from the first RT. Surgical resection before re-RT was performed in 19% of patients, concomitant temozolomide (TMZ) in 16.3%, and maintenance chemotherapy in 29%. Total doses ranged from 9 Gy to 52.5 Gy, with a median biological effective dose of 43 Gy. The median, 1, 2 year OS were 9.7 months, 41% and 17.7%. Low grade glioma histology (p  ≪ 0.01), IT > 12 months (p = 0.001), KPS > 70 (p = 0.004), younger age (p = 0.001), high total doses delivered (p = 0.04), and combined treatment performed (p = 0.0008) were recorded as conditioning survival.

CONCLUSION: our data underline re-RT as a safe and feasible treatment with limited rate of toxicity, and a combined ones as a better option for selected patients. The identification of a BED threshold able to obtain a greater benefit on OS, can help in designing future prospective studies.

Original languageEnglish
JournalJournal of Neuro-Oncology
DOIs
Publication statusE-pub ahead of print - Dec 4 2018

Fingerprint

Radiation Oncology
Glioma
Multicenter Studies
temozolomide
Maintenance Chemotherapy
Neurologic Examination
Adjuvant Chemotherapy
Standard of Care
Italy
Re-Irradiation
Histology
Radiotherapy
Therapeutics
Prospective Studies
Recurrence
Survival
Brain

Cite this

Re-irradiation for recurrent glioma : outcome evaluation, toxicity and prognostic factors assessment. A multicenter study of the Radiation Oncology Italian Association (AIRO). / Navarria, Pierina; Minniti, Giuseppe; Clerici, Elena; Tomatis, Stefano; Pinzi, Valentina; Ciammella, Patrizia; Galaverni, Marco; Amelio, Dante; Scartoni, Daniele; Scoccianti, Silvia; Krengli, Marco; Masini, Laura; Draghini, Lorena; Maranzano, Ernesto; Borzillo, Valentina; Muto, Paolo; Ferrarese, Fabio; Fariselli, Laura; Livi, Lorenzo; Pasqualetti, Francesco; Fiorentino, Alba; Alongi, Filippo; di Monale, Michela Buglione; Magrini, Stefano; Scorsetti, Marta.

In: Journal of Neuro-Oncology, 04.12.2018.

Research output: Contribution to journalArticle

Navarria, Pierina ; Minniti, Giuseppe ; Clerici, Elena ; Tomatis, Stefano ; Pinzi, Valentina ; Ciammella, Patrizia ; Galaverni, Marco ; Amelio, Dante ; Scartoni, Daniele ; Scoccianti, Silvia ; Krengli, Marco ; Masini, Laura ; Draghini, Lorena ; Maranzano, Ernesto ; Borzillo, Valentina ; Muto, Paolo ; Ferrarese, Fabio ; Fariselli, Laura ; Livi, Lorenzo ; Pasqualetti, Francesco ; Fiorentino, Alba ; Alongi, Filippo ; di Monale, Michela Buglione ; Magrini, Stefano ; Scorsetti, Marta. / Re-irradiation for recurrent glioma : outcome evaluation, toxicity and prognostic factors assessment. A multicenter study of the Radiation Oncology Italian Association (AIRO). In: Journal of Neuro-Oncology. 2018.
@article{d60c4b986d764864ae6eefcc6c47f239,
title = "Re-irradiation for recurrent glioma: outcome evaluation, toxicity and prognostic factors assessment. A multicenter study of the Radiation Oncology Italian Association (AIRO)",
abstract = "INTRODUCTION: The prognosis of glioma is dismal, and almost all patients relapsed. At recurrence time, several treatment options are considered, but to date there is no a standard of care. The Neurooncology Study Group of the Italian Association of Radiation Oncology (AIRO) collected clinical data regarding a large series of recurrent glioma patients who underwent re-irradiation (re-RT) in Italy.METHODS: Data regarding 300 recurrent glioma patients treated from May 2002 to November 2017, were analyzed. All patients underwent re-RT. Surgical resection, followed by re-RT with concomitant and adjuvant chemotherapy was performed. Clinical outcome was evaluated by neurological examination and brain MRI performed, 1 month after radiation therapy and then every 3 months.RESULTS: Re-irradiation was performed at a median interval time (IT) of 16 months from the first RT. Surgical resection before re-RT was performed in 19{\%} of patients, concomitant temozolomide (TMZ) in 16.3{\%}, and maintenance chemotherapy in 29{\%}. Total doses ranged from 9 Gy to 52.5 Gy, with a median biological effective dose of 43 Gy. The median, 1, 2 year OS were 9.7 months, 41{\%} and 17.7{\%}. Low grade glioma histology (p  ≪ 0.01), IT > 12 months (p = 0.001), KPS > 70 (p = 0.004), younger age (p = 0.001), high total doses delivered (p = 0.04), and combined treatment performed (p = 0.0008) were recorded as conditioning survival.CONCLUSION: our data underline re-RT as a safe and feasible treatment with limited rate of toxicity, and a combined ones as a better option for selected patients. The identification of a BED threshold able to obtain a greater benefit on OS, can help in designing future prospective studies.",
author = "Pierina Navarria and Giuseppe Minniti and Elena Clerici and Stefano Tomatis and Valentina Pinzi and Patrizia Ciammella and Marco Galaverni and Dante Amelio and Daniele Scartoni and Silvia Scoccianti and Marco Krengli and Laura Masini and Lorena Draghini and Ernesto Maranzano and Valentina Borzillo and Paolo Muto and Fabio Ferrarese and Laura Fariselli and Lorenzo Livi and Francesco Pasqualetti and Alba Fiorentino and Filippo Alongi and {di Monale}, {Michela Buglione} and Stefano Magrini and Marta Scorsetti",
year = "2018",
month = "12",
day = "4",
doi = "10.1007/s11060-018-03059-x",
language = "English",
journal = "Journal of Neuro-Oncology",
issn = "0167-594X",
publisher = "Springer New York LLC",

}

TY - JOUR

T1 - Re-irradiation for recurrent glioma

T2 - outcome evaluation, toxicity and prognostic factors assessment. A multicenter study of the Radiation Oncology Italian Association (AIRO)

AU - Navarria, Pierina

AU - Minniti, Giuseppe

AU - Clerici, Elena

AU - Tomatis, Stefano

AU - Pinzi, Valentina

AU - Ciammella, Patrizia

AU - Galaverni, Marco

AU - Amelio, Dante

AU - Scartoni, Daniele

AU - Scoccianti, Silvia

AU - Krengli, Marco

AU - Masini, Laura

AU - Draghini, Lorena

AU - Maranzano, Ernesto

AU - Borzillo, Valentina

AU - Muto, Paolo

AU - Ferrarese, Fabio

AU - Fariselli, Laura

AU - Livi, Lorenzo

AU - Pasqualetti, Francesco

AU - Fiorentino, Alba

AU - Alongi, Filippo

AU - di Monale, Michela Buglione

AU - Magrini, Stefano

AU - Scorsetti, Marta

PY - 2018/12/4

Y1 - 2018/12/4

N2 - INTRODUCTION: The prognosis of glioma is dismal, and almost all patients relapsed. At recurrence time, several treatment options are considered, but to date there is no a standard of care. The Neurooncology Study Group of the Italian Association of Radiation Oncology (AIRO) collected clinical data regarding a large series of recurrent glioma patients who underwent re-irradiation (re-RT) in Italy.METHODS: Data regarding 300 recurrent glioma patients treated from May 2002 to November 2017, were analyzed. All patients underwent re-RT. Surgical resection, followed by re-RT with concomitant and adjuvant chemotherapy was performed. Clinical outcome was evaluated by neurological examination and brain MRI performed, 1 month after radiation therapy and then every 3 months.RESULTS: Re-irradiation was performed at a median interval time (IT) of 16 months from the first RT. Surgical resection before re-RT was performed in 19% of patients, concomitant temozolomide (TMZ) in 16.3%, and maintenance chemotherapy in 29%. Total doses ranged from 9 Gy to 52.5 Gy, with a median biological effective dose of 43 Gy. The median, 1, 2 year OS were 9.7 months, 41% and 17.7%. Low grade glioma histology (p  ≪ 0.01), IT > 12 months (p = 0.001), KPS > 70 (p = 0.004), younger age (p = 0.001), high total doses delivered (p = 0.04), and combined treatment performed (p = 0.0008) were recorded as conditioning survival.CONCLUSION: our data underline re-RT as a safe and feasible treatment with limited rate of toxicity, and a combined ones as a better option for selected patients. The identification of a BED threshold able to obtain a greater benefit on OS, can help in designing future prospective studies.

AB - INTRODUCTION: The prognosis of glioma is dismal, and almost all patients relapsed. At recurrence time, several treatment options are considered, but to date there is no a standard of care. The Neurooncology Study Group of the Italian Association of Radiation Oncology (AIRO) collected clinical data regarding a large series of recurrent glioma patients who underwent re-irradiation (re-RT) in Italy.METHODS: Data regarding 300 recurrent glioma patients treated from May 2002 to November 2017, were analyzed. All patients underwent re-RT. Surgical resection, followed by re-RT with concomitant and adjuvant chemotherapy was performed. Clinical outcome was evaluated by neurological examination and brain MRI performed, 1 month after radiation therapy and then every 3 months.RESULTS: Re-irradiation was performed at a median interval time (IT) of 16 months from the first RT. Surgical resection before re-RT was performed in 19% of patients, concomitant temozolomide (TMZ) in 16.3%, and maintenance chemotherapy in 29%. Total doses ranged from 9 Gy to 52.5 Gy, with a median biological effective dose of 43 Gy. The median, 1, 2 year OS were 9.7 months, 41% and 17.7%. Low grade glioma histology (p  ≪ 0.01), IT > 12 months (p = 0.001), KPS > 70 (p = 0.004), younger age (p = 0.001), high total doses delivered (p = 0.04), and combined treatment performed (p = 0.0008) were recorded as conditioning survival.CONCLUSION: our data underline re-RT as a safe and feasible treatment with limited rate of toxicity, and a combined ones as a better option for selected patients. The identification of a BED threshold able to obtain a greater benefit on OS, can help in designing future prospective studies.

U2 - 10.1007/s11060-018-03059-x

DO - 10.1007/s11060-018-03059-x

M3 - Article

C2 - 30515706

JO - Journal of Neuro-Oncology

JF - Journal of Neuro-Oncology

SN - 0167-594X

ER -