title: Validation of the prognostic Heidelberg re-irradiation score in an independent mono-institutional patient cohort.
abstract: OBJECTIVE
  Re-irradiation has been shown to be a valid option with proven efficacy for recurrent high-grade glioma patients. Overall, up to now it is unclear which patients might be optimal candidates for a second course of irradiation. A recently reported prognostic score developed by Combs et al. may guide treatment decisions and thus, our mono-institutional cohort served as validation set to test its relevance for clinical practice.
  
  
  METHODS
  The prognostic score is built upon histology, age (< 50 vs. ≥ 50 years) and the time between initial radiotherapy and re-irradiation (≤ 12 vs. > 12 months). This score was initially introduced to distinguish patients with excellent (0 points), good (1 point), moderate (2 points) and poor (3-4 points) post-recurrence survival (PRS) after re-irradiation. Median prescribed radiation dose during re-treatment of recurrent malignant glioma was 36 Gy in 2 Gy single fractions. A substantial part of the patients was additionally treated with bevacizumab (10 mg/kg intravenously at d1 and d15 during re-irradiation).
  
  
  RESULTS
  88 patients (initially 61 WHO IV, 20 WHO III, 7 WHO II) re-irradiated in a single institution were retrospectively analyzed. Median follow-up was 30 months and median PRS of the entire patient cohort 7 months. Seventy-one patients (80.7%) received bevacizumab. PRS was significantly increased in patients receiving bevacizumab (8 vs. 6 months, p = 0.027, log-rank test). KPS, age, MGMT methylation status, sex, WHO grade and the Heidelberg score showed no statistically significant influence on neither PR-PFS nor PRS.
  
  
  CONCLUSIONS
  In our cohort which was mainly treated with bevacizumab the usefulness of the Heidelberg score could not be confirmed probably due to treatment heterogeneity; it can be speculated that larger multicentric data collections are needed to derive a more reliable score.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Niyazi
authors.forename: Maya
authors.initials: M
authors.lastname: Flieger
authors.forename: Ute
authors.initials: U
authors.lastname: Ganswindt
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Combs
authors.affiliation: Department of Radiation Oncology, University of Munich, Marchioninistr, 15, 81377 Munich, Germany. Claus.Belka@med.uni-muenchen.de.
authors.forename: Claus
authors.initials: C
authors.lastname: Belka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult