gms | German Medical Science

Objective: In contrast to the primary treatment of glioblastoma, the treatment options for recurrent GBM are not well defined. Re-radiation is now considered an additional treatment option, if primary radiation has been performed with time interval of at least 12 months. Here, we report our first experience with re-radiation after pre-treatment with the Stupp-protocol.

Method: Patients suffering from recurrent GBM with a time interval of at least 12 months to primary treatment were considered for re-radiation. Treatment was (as compassionate use) with focal re-radiation (target volume 40 Gy, 5x 2,67Gy/week) plus concomitant chemotherapy with temozolomide. Retrospectively, we analysed survival and quality of life in these patients. Grade of independency was assessed by KPS and NIH.

Results: Since 2008, 12 glioblastoma patients (median age 60.8 years; 10 prim. GBM patients, 2 sek. GBM patients) were treated with re-radiation (5x 2,67 gy/week, target volume 40 gy) plus 75 mg/m² TMZ chemotherapy. Because of de novo manifestation and distant localization, two patients received 60Gy. In 7 patients re-radiation was accomplished as second line therapy, in 4 patients as third line therapy, in one patient as fourth line therapy. Tumor recurrence was diagnosed solely by MRI in three patients, in two patients additional FET-PET analysis confirmed the diagnosis, 7 patients underwent re-resection prior to radiation therapy. Mean interval between the first and the second radiation therapy was 25.6 months (range 12–48 months). Mean OAS was 32.5 months (5 patients are still alive), mean TTP after re-radiation therapy 4.6 months. Due to incompliance and skin irritation, re-radiation therapy was disrupted in two patients. Following re-radiation and concomitant TMZ therapy, in 8 patients TMZ therapy was continued (5/23 scheme, median 3 cycles), one patient received ACNU chemotherapy, in three patients therapy was discontinued due to tumor progression. One patient developed a severe leucencephalopathy. Median KPS prior to re-radiation was 90, NIH 1; post re-radiation KPS 80, NIH 2.

Conclusions: Though the small number of patients does not allow definitive conclusions, re-radiation was surprisingly well tolerated, with only minor changes regarding KPS and NIH score. Prospective randomized trials should clarify the impact of this treatment modality in the near future.