Angela Caroli, Lorenzo Vinante, Paola Chiovati, Maria Antonietta Annunziata, Roberto Bortolus, Martina Urbani, Tamara Ius, Miran Skrap and Mauro Arcicasa
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.
