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  • 2018년 09월호
    [Radiother Oncol.] Survival gain with re-Op/RT for recurred high-grade gliomas depends upon risk groups.

    서울의대 / 전석주, 김일한*

  • 출처
    Radiother Oncol.
  • 등재일
    2018 Aug
  • 저널이슈번호
    128(2):254-259. doi: 10.1016/j.radonc.2018.05.024. Epub 2018 Jun 21.
  • 내용

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    Abstract
    INTRODUCTION:
    A majority of high-grade gliomas relapse despite combined surgery, radiotherapy and chemotherapy. There is no consensus on standard treatment for recurrent high-grade gliomas, or defined efficacy of adjuvant re-RT after re-Op. This retrospective study evaluated the benefit and safety of re-RT after re-Op (re-Op/RT).

    MATERIALS AND METHODS:
    A total of 84 patients with recurrent high-grade gliomas who underwent reoperation from 2009 to 2015 were analyzed. All patients received neurosurgical intervention and adjuvant radiotherapy previously before recurrence. At recurrence and after reoperation, treatment options were discussed in multidisciplinary clinic or brain tumor joint conference. For re-RT, cumulative EQD2 (equivalent dose in 2 Gy fractions at α/β = 2) was below 106.9 Gy.

    RESULT:
    Median progression free survival (PFS) was 6.5 months; 3.5 months with re-Op, 9.0 months with re-Op/RT (p = 0.025). Age <50, time interval to recur ≥12 months, WHO pathologic grade III, methylated MGMT promotor, and re-RT were factors enhancing PFS in the multivariate analysis. Median overall survival (OS) was 18.3 months: 12.7 months with re-Op, and 28.1 months with re-Op/RT (p = 0.066). Three risk factors (age >50, WHO grade IV, and unmethylated promoter of MGMT) were significantly associated with poor OS in multivariate analysis. Benefit of re-RT in both OS and PFS was established in patients carrying 2 or more risk factors. During re-RT, 4 patients (8%) had grade 2 or higher toxicity, and 3 patients (6%) did not complete re-RT. No radionecrosis was observed.

    CONCLUSION:
    Re-RT after re-Op was tolerable with a cumulative median EQD2 of 99.3 Gy and resulted in clear benefit in PFS and marginal gain in OS. Survival gain with re-Op/RT was more prominent in patients with two or more risk factors (age ≥50, WHO pathologic grade IV, unmethylated MGMT promoter), and needs to be validated.

     


    Author information

    Chun SJ1, Park SH2, Park CK3, Kim JW4, Kim TM5, Choi SH6, Lee ST7, Kim IH8.
    1
    Department of Radiation Oncology, Seoul National University College of Medicine, South Korea.
    2
    Department of Pathology, Seoul National University College of Medicine, South Korea.
    3
    Department of Neurosurgery, Seoul National University College of Medicine, South Korea; Cancer Research Institute, Seoul National University, South Korea.
    4
    Department of Neurosurgery, Seoul National University College of Medicine, South Korea.
    5
    Department of Internal Medicine, Seoul National University College of Medicine, South Korea.
    6
    Department of Radiology, Seoul National University College of Medicine, South Korea.
    7
    Department of Neurology, Seoul National University College of Medicine, South Korea.
    8
    Department of Radiation Oncology, Seoul National University College of Medicine, South Korea; Cancer Research Institute, Seoul National University, South Korea. Electronic address: ihkim@snu.ac.kr.

  • 키워드
    Glioblastoma; High-grade glial tumor; Re-irradiation; Re-operation; Recurrence
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