title: Hypofractionated Stereotactic Radiation Therapy in Recurrent High-Grade Glioma: A New Challenge.
abstract: OBJECTIVE
  The aim of this study was to evaluate outcomes of hypofractionated stereotactic radiation therapy (HSRT) in patients re-treated for recurrent high-grade glioma.
  
  
  METHODS
  From January 2006 to September 2013, 25 patients were treated. Six patients underwent radiation therapy alone, while 19 underwent combined treatment with surgery and/or chemotherapy. Only patients with Karnofsky Performance Status (KPS) > 70 and time from previous radiotherapy greater than 6 months were re-irradiated. The mean recurrent tumor volume was 35 cm(3) (range, 2.46 to 116.7 cm(3)), and most of the patients (84%) were treated with a total dose of 25 Gy in five fractions (range, 20 to 50 Gy in 5-10 fractions).
  
  
  RESULTS
  The median follow-up was 18 months (range, 4 to 36 months). The progression-free survival (PFS) at 1 and 2 years was 72% and 34% and the overall survival (OS) 76% and 50%, respectively. No severe toxicity was recorded. In univariate and multivariate analysis extent of resection at diagnosis significantly influenced PFS and OS (p < 0.01). Patients with smaller recurren tumor volume treated had better local control and survival. Indeed, the 2-year PFS was 40% (≤ 50 cm(3)) versus 11% (p=0.1) and the 2-year OS 56% versus 33% (> 50 cm(3)), respectively (p=0.26).
  
  
  CONCLUSIONS
  In our experience, HSRT could be a safe and feasible therapeutic option for recurrent high grade glioma even in patients with larger tumors. We believe that a multidisciplinary evaluation is mandatory to assure the best treatment for selected patients. Local treatment should also be considered as part of an integrated approach.
authors.affiliation: Department of Radiotherapy and Radiosurgery, Istituto Clinico Humanitas Cancer Center and Research Hospital, Milano, Italy.
authors.forename: Pierina
authors.initials: P
authors.lastname: Navarria
authors.affiliation: Department of Radiotherapy and Radiosurgery, Istituto Clinico Humanitas Cancer Center and Research Hospital, Milano, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ascolese
authors.affiliation: Department of Radiotherapy and Radiosurgery, Istituto Clinico Humanitas Cancer Center and Research Hospital, Milano, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tomatis
authors.affiliation: Department of Radiotherapy and Radiosurgery, Istituto Clinico Humanitas Cancer Center and Research Hospital, Milano, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Reggiori
authors.affiliation: Department of Radiotherapy and Radiosurgery, Istituto Clinico Humanitas Cancer Center and Research Hospital, Milano, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Clerici
authors.affiliation: Department of Radiotherapy and Radiosurgery, Istituto Clinico Humanitas Cancer Center and Research Hospital, Milano, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Villa
authors.affiliation: Department of Radiotherapy and Radiosurgery, Istituto Clinico Humanitas Cancer Center and Research Hospital, Milano, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Maggi
authors.affiliation: Department of Radiotherapy and Radiosurgery, Istituto Clinico Humanitas Cancer Center and Research Hospital, Milano, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bello
authors.affiliation: Department of Neurosurgical Oncology, Istituto Clinico Humanitas Cancer Center and Research Hospital, Milano, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pessina
authors.affiliation: Department of Radiotherapy and Radiosurgery, Istituto Clinico Humanitas Cancer Center and Research Hospital, Milano, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.affiliation: Department of Radiotherapy and Radiosurgery, Istituto Clinico Humanitas Cancer Center and Research Hospital, Milano, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D005910:Glioma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D016634:Radiosurgery / Q000009:adverse effects; D012189:Retrospective Studies; D055815:Young Adult
keywords: Glioma; Radiosurgery; Retreatment