title: Re-irradiation or re-operation followed by dendritic cell vaccination? Comparison of two different salvage strategies for relapsed high-grade gliomas by means of a new prognostic model.
abstract: We aimed to compare two different salvage treatment strategies for relapsed high-grade glioma (HGG) patients by means of a new prognostic model. A simplified version of the so-called HGG-Immuno RPA model estimates the prognosis of relapsed HGG patients and distinguishes three different prognostic classes (I = good, II = intermediate, III = poor). The model has been constructed with a cohort of 117 patients whose salvage treatment consisted of re-operation followed by dendritic cell vaccination (ReOP + DCV). However, using only the predictors histology, age and performance status, the simplified HGG-Immuno RPA model is basically independent from treatment. In the present study we applied the simplified model to the cohort used to construct the original HGG-Immuno RPA model and another cohort of 165 patients who underwent re-irradiation (ReRT) at relapse. Then, we compared the outcomes achieved by the two different salvage treatments in each prognostic class. The model predicted good, intermediate and poor prognosis for 11, 31 and 75 patients of the ReOP + DCV cohort and for 20, 39 and 106 patients of the ReRT cohort, respectively. Neither of the two strategies was superior to the other. In the groups with good, intermediate and poor prognosis 12-months survival rates were 73, 59 and 25 % after ReOP + DCV and 72, 36 and 23 % after ReRT, respectively. Being easy to handle and independent from treatment, the aforementioned model is useful for therapeutic decisions. ReRT and ReOP + DVC seem to be equally effective. The choice of salvage treatment should be based on the expected side effects.
authors.affiliation: Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany. klausmueller1978@googlemail.com.|Department of Radiation Oncology, Hospital Chemnitz, Bürgerstraße 2, 09113, Chemnitz, Germany. klausmueller1978@googlemail.com.
authors.forename: Klaus
authors.initials: K
authors.lastname: Müller
authors.affiliation: Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.|Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Henke
authors.affiliation: Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany.
authors.forename: Sophie
authors.initials: S
authors.lastname: Pietschmann
authors.affiliation: Laboratory of Experimental Immunology, Catholic University Leuven, Leuven, Belgium.
authors.forename: Stefaan
authors.initials: S
authors.lastname: van Gool
authors.affiliation: Laboratory of Experimental Immunology, Catholic University Leuven, Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: De Vleeschouwer
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: André O
authors.initials: AO
authors.lastname: von Bueren
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW (School for Oncology & Developmental Biology), University of Maastricht Medical Center, Maastricht, The Netherlands.
authors.forename: Inge
authors.initials: I
authors.lastname: Compter
authors.affiliation: Division of Pediatric Oncology, Hematology and Hemostaseology, Department of Woman's and Children's Health, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Friedrich
authors.affiliation: Department of Radiation Oncology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Matuschek
authors.affiliation: Department of Radiation Oncology, Hospital Chemnitz, Bürgerstraße 2, 09113, Chemnitz, Germany.
authors.forename: Gunther
authors.initials: G
authors.lastname: Klautke
authors.affiliation: Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany.
authors.forename: Rolf-Dieter
authors.initials: RD
authors.lastname: Kortmann
authors.affiliation: Departments of Neurology and Haematology/Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hundsberger
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW (School for Oncology & Developmental Biology), University of Maastricht Medical Center, Maastricht, The Netherlands.|Clinical Cooperation Unit Neurooncology, Department of Radiation Oncology, MediClin Robert Janker Clinic & University of Bonn Medical Center, Bonn, Germany.
authors.forename: Brigitta G
authors.initials: BG
authors.lastname: Baumert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019496:Cancer Vaccines / Q000008:administration & dosage* / Q000627:therapeutic use*; D015331:Cohort Studies; D003713:Dendritic Cells / Q000276:immunology*; D005910:Glioma / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D008954:Models, Biological; D060787:Neoplasm Grading; D011379:Prognosis; D016016:Proportional Hazards Models; D000069475:Re-Irradiation / Q000379:methods*; D012008:Recurrence; D012086:Reoperation / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019496:Cancer Vaccines
keywords: Dendritic cell vaccination; Prognosis; Prognostic model; Re-irradiation; Recurrent glioblastoma; Relapsed high-grade gliomas; Salvage treatment