방사선의학 웹진

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Abstract
Background: Patients with glioblastoma (GBM) often have disease progression after standard temozolomide-based chemoradiation. The benefits and optimal use of re-irradiation (re-RT) following re-operation (re-OP) in recurrent GBM (rGBM) remain uncertain. In this study, we assessed the efficacy and safety of post-operative re-RT in patients with isocitrate dehydrogenase-wild-type rGBM, aiming to identify survival benefits and determine clinicogenetic criteria for patient selection.

Patients and methods: Data from the Korean Radiation Oncology Group 21-02 retrospective study were evaluated, including 531 patients with rGBM from 2013 to 2019. A subset of 164 patients undergoing re-OP were analyzed for survival and benefits of post-operative re-RT. Additionally, 206 patients receiving re-RT, irrespective of re-OP, were evaluated for risks of radiation necrosis. The overall survival (OS) after re-OP was the primary endpoint. Statistical analyses included the Kaplan-Meier method and log-rank test for OS, Cox proportional hazards regression model for univariate and multivariate analyses, and the Fine-Gray competing risk model for assessing the risk of brain necrosis.

Results: The median OS after re-OP was 13.4 months. Kaplan-Meier analysis revealed significantly better OS for those who received re-RT (17.6 months) than for those who did not (11.0 months; P = 0.002). Factors associated with improved OS included higher Karnofsky performance status scores, post-operative re-RT, and additional systemic therapy after re-OP. Factors associated with adverse outcomes included recurrence outside the initial RT field and homozygous deletion of CDKN2A/B. The incidence of grade 2 or higher RT necrosis was 5.8% among those undergoing both re-OP and post-operative re-RT.

Conclusion: Post-operative re-RT appears to be associated with enhanced survival and minimal toxicity in patients with rGBM following temozolomide chemoradiation. Our study suggests a novel clinicogenetic criterion for re-RT after re-OP in rGBM, which requires further validation.

그림 재발성 교모세포종에서 재수술 후 재방사선치료에 따른 전체생존율. 전체 환자에서 수술 후 재방사선치료는 생존기간 연장과 연관되었으며(A), 임상·유전학적 선호 요인을 2개 이상 가진 환자군에서 그 이득이 특히 뚜렷하게 나타났다(C).

Affiliations

S Park 1, D Kim 2, H I Yoon 3, J H Lee 4, D H Lim 5, N Kim 5, J H Song 6, C-O Suh 7, C W Wee 8, I A Kim 9
1Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea; Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Korea.
2Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea; Department of Radiation Oncology, Chungnam National University Hospital, Daejeon, Korea.
3Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea; Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
4Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.
5Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
6Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University, Seoul, Korea.
7Department of Radiation Oncology, Bundang CHA Medical Center, CHA University, Seongnam, Korea.
8Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea; Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea. Electronic address: wcw0108@yuhs.ac.
9Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea; Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea. Electronic address: inah228@snu.ac.kr

참고논문 Click : [Neurosurgery .] Optimizing Recurrent Glioblastoma Salvage Treatment: A Multicenter Study Integrating Genetic Biomarkers From the Korean Radiation Oncology Group (21-02)재발성 교모세포종의 구제 치료: 유전적 바이오마커를 통합 분석한 대한방사선종양학회 연구위원회 다기관 연구 (KROG 21-02)