title: Re-resection for recurrent high-grade glioma in the setting of re-irradiation: more is not always better.
abstract: The optimal treatment for patients with recurrent high grade glioma (HGG) remains controversial. Available therapies include surgery, re-irradiation, alternating electric fields or systemic therapy. Here we investigate whether re-resection will improve survival in patients receiving repeat radiotherapy for tumor recurrence. 231 consecutive patients with recurrent HGG treated with re-irradiation between 1994 and 2012 were analyzed. 105 patients underwent re-resection. Re-irradiation was delivered using daily fractions of 3.5 Gy to a median total dose of 35 Gy. Survival was then analyzed comparing patients with and without re-resection. Overall survival (OS) and survival from the first recurrence are reported. Univariate and cox-proportional hazard modeling was performed in a step-wise multivariate analysis using known prognostic factors. The median follow-up time from initial diagnosis was 25.7 months. The median OS from initial diagnosis of the entire group was 22.5 months. There was no significant difference in median overall survival between patients who received re-resection versus no re-resection, 23 versus 21.9 months respectively (p = 0.6). Additionally, there was no difference in median survival from the time of first recurrence 10.5 months without re-resection versus 11.1 months with re-resection (p = 0.09). After adjusting for known prognostic variables, only age remained significant. Re-irradiation is an effective salvage therapy for patients with localized, progressive high grade glioma, achieving a median survival of 10-11 months from re-irradiation. Our data reveals no significant improvement in survival with the addition of re-resection to re-irradiated patients with HGG.
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College at Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 South 11th Street, Philadelphia, PA, 19107, USA. Joshua.palmer@jefferson.edu.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Palmer
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, UPMC Cancer Center at UPMC St. Margaret, 200 Delafield Road, Pittsburgh, PA, 15215, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Siglin
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College at Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 South 11th Street, Philadelphia, PA, 19107, USA.
authors.forename: Kosj
authors.initials: K
authors.lastname: Yamoah
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College at Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 South 11th Street, Philadelphia, PA, 19107, USA.
authors.forename: Tu
authors.initials: T
authors.lastname: Dan
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, UPMC Cancer Center at UPMC St. Margaret, 200 Delafield Road, Pittsburgh, PA, 15215, USA.
authors.forename: Colin E
authors.initials: CE
authors.lastname: Champ
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College at Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 South 11th Street, Philadelphia, PA, 19107, USA.
authors.forename: Voichita
authors.initials: V
authors.lastname: Bar-Ad
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College at Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 South 11th Street, Philadelphia, PA, 19107, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Werner-Wasik
authors.affiliation: Department of Neurological Surgery, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College at Thomas Jefferson University, 909 Walnut St #3, Philadelphia, PA, 19107, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Evans
authors.affiliation: Department of Neurology, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College at Thomas Jefferson University, 909 Walnut St #3, Philadelphia, PA, 19107, USA.
authors.forename: Lyndon
authors.initials: L
authors.lastname: Kim
authors.affiliation: Department of Neurology, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College at Thomas Jefferson University, 909 Walnut St #3, Philadelphia, PA, 19107, USA.
authors.forename: Jon
authors.initials: J
authors.lastname: Glass
authors.affiliation: Department of Neurological Surgery, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College at Thomas Jefferson University, 909 Walnut St #3, Philadelphia, PA, 19107, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Farrell
authors.affiliation: Department of Neurological Surgery, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College at Thomas Jefferson University, 909 Walnut St #3, Philadelphia, PA, 19107, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Andrews
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College at Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 South 11th Street, Philadelphia, PA, 19107, USA.
authors.forename: Wenyin
authors.initials: W
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D000069475:Re-Irradiation; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult
keywords: Fractionated stereotactic radiotherapy; Overall survival; Re-resection; Recurrent high-grade glioma