title: The evolving role for re-irradiation in the management of recurrent grade 4 glioma.
abstract: Although significant gains have been realized in the management of grade 4 glioma, the majority of these patients will ultimately suffer local recurrence within the prior field of treatment. Clearly, novel local treatment strategies are required to improve patient outcomes. Concerns of toxicity have limited enthusiasm for the utilization of re-irradiation as a treatment option. However, using modern imaging technology and precision radiotherapy delivery techniques re-irradiation has proven a feasible option achieving both a palliative benefit and prolongation of survival with low toxicity rates. The evolution of re-irradiation as a treatment modality for recurrent grade 4 glioma is reviewed. In addition, potential targeted radiosensitizers to be used in conjunction with re-irradiation are also discussed.
authors.affiliation: Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, K4/350 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA. howard@humonc.wisc.edu.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Howard
authors.affiliation: Radiation Oncology Branch, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Andra
authors.initials: A
authors.lastname: Krauze
authors.affiliation: Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Mike D
authors.initials: MD
authors.lastname: Chan
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Tsien
authors.affiliation: Department of Radiation Oncology and Department of Neurology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Tomé
mesh_terms: D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D005910:Glioma / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy*; D010166:Palliative Care; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D000069475:Re-Irradiation / Q000379:methods
chemical_list: D011838:Radiation-Sensitizing Agents
keywords: Central nervous system; Radiosensitizers; Re-irradiation; Recurrent grade 4 glioma