Radiation-induced malignant gliomas: is there a role for reirradiation?
OBJECTIVE
To review the literature regarding the role of radiotherapy (RT) in the treatment of patients with radiation-induced malignant gliomas (RIMGs).


METHODS
A PubMed search of English-language articles dealing with RIMG was performed, yielding 52 articles with 92 patients available for review.


RESULTS
Initial tumor types treated with RT included brain tumor in 37 patients (40%), acute lymphoblastic leukemia in 33 (36%), benign disease in 11 (12%), and other in 11 (12%). Median time from RT to development of an RIMG was 8.75 years (range, 2.5-61 years). The RIMG occurred within 10 years after RT in 81% of patients with acute lymphoblastic leukemia/lymphoma, 59% of patients with brain/other, and 18% of patients with benign conditions (p = 0.002). Type of RIMG was glioblastoma in 69 (75%) and anaplastic astrocytoma in 23 (25%). One-, 2-, and 5-year overall survival rates were 29.3%, 7.3%, and 0% for patients with glioblastoma and 59.7%, 30.3%, and 20.2% for patients with anaplastic astrocytoma. For the 85 patients with data regarding treatment for RIMG, 35 underwent reirradiation to a median dose of 50 Gy (range, 30-76 Gy). For patients undergoing reirradiation, 1-, 2- and 5-year overall survival rates were 58.9%, 20.5%, and 6.8%. For those not undergoing reirradiation, they were 15.1%, 3%, and 0% (p = 0.0009).


CONCLUSIONS
The RIMG appeared earlier in patients treated for leukemia and lymphoma and latest for those treated for a benign condition. Patients who underwent reirradiation for RIMG have longer survival times compared with those not receiving RT.
Paulino
Arnold C
AC
Department of Radiology, Division of Radiation Oncology, Baylor College of Medicine, 6565 Fannin Street, Houston, TX 77030, USA. apaulino@tmh.tmc.edu
Mai
Wei Y
WY
Chintagumpala
Murali
M
Taher
Abida
A
Teh
Bin S
BS
D001254:Astrocytoma / Q000532:radiotherapy; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D005909:Glioblastoma / Q000532:radiotherapy; D005910:Glioma / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D009381:Neoplasms, Radiation-Induced / Q000532:radiotherapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000532:radiotherapy; D019233:Retreatment; D015996:Survival Rate