Hypofractionated reirradiation for recurrent malignant glioma.
OBJECTIVE
Treatment options for recurrent high-grade glioma after a complete course of radiotherapy comprise surgery, reirradiation and chemotherapy but the efficacy of any of the given salvage treatments is limited. In order to further define the role of short-term radiotherapy as retreatment option for selected patients, we analyzed outcomes after treatment with a hypofractionated radiation.


METHODS
Treatment outcomes (overall survival and treatment-associated toxicity) were analyzed retrospectively in 31 patients treated between 1994 and 2007. Hypofractionated radiotherapy was performed after three-dimensional CT planning with a median total dose of 20 Gy in a single department.


RESULTS
With a median interval of 20 months from primary radiotherapy, two grade III and 29 grade IV tumors were reirradiated. Pretreatment consisted of surgery and involved-field radiotherapy (median 59 Gy). 77% of the patients received additional chemotherapy before the second course of radiotherapy, and 48% were treated after secondary resection. The median overall survival after hypofractionated radiotherapy was 10.2 months, and the median overall survival time after primary diagnosis 30.9 months. No severe toxicity was observed.


CONCLUSIONS
Hypofractionated reirradiation with 20 Gy given over 1 week is a practicable and well-tolerated treatment option for patients with recurrent malignant glioma. The overall survival was comparable to the reported outcomes from other series including those with longer treatment protocols.
Henke
Guido
G
Department of Radiooncology, University Hospital, Tübingen, Germany. guido.henke@med.uni-tuebingen.de
Paulsen
Frank
F
Steinbach
Joachim P
JP
Ganswindt
Ute
U
Isijanov
Hana
H
Kortmann
Rolf-Dieter
RD
Bamberg
Michael
M
Belka
Claus
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D005858:Germany / Q000453:epidemiology; D005910:Glioma / Q000401:mortality* / Q000532:radiotherapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000532:radiotherapy*; D020266:Radiotherapy, Conformal / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult