PMID- 33528810 OWN - NLM STAT- MEDLINE DCOM- 20211223 LR - 20211223 IS - 1699-3055 (Electronic) IS - 1699-048X (Linking) VI - 23 IP - 7 DP - 2021 Jul TI - High-dose salvage re-irradiation for recurrent/progressive adult diffuse glioma: healing or hurting? PG - 1358-1367 LID - 10.1007/s12094-020-02526-0 [doi] AB - PURPOSE: To report survival outcomes and identify prognostic factors of salvage re-irradiation (re-RT) in recurrent/progressive glioma. METHODS: Medical records of patients treated with high-dose re-RT as part of multi-modality salvage therapy for recurrence/progression of adult diffuse glioma from 2010 to 2019 were analyzed retrospectively. RESULTS: A total of 111 patients developing recurrent/progressive high-grade glioma after adequate upfront treatment at initial diagnosis were included. The first course of radiotherapy (RT) had been delivered to a median dose of 59.4 Gy with an inter-quartile range (IQR) of 54-60 Gy. Median time to recurrence/progression was 4.3 years (IQR = 2.3-7.4 years) while the median time to re-RT was 4.8 years (IQR = 3.6-7.9 years). Re-RT was delivered with intensity-modulated radiation therapy (IMRT) using 1.8 Gy/fraction to a median dose of 54 Gy (IQR = 50.4-55.8 Gy) for a cumulative median equivalent dose in 2-Gy fractions (EQD2) of 104.3 Gy (IQR = 102.6-109.4 Gy). At a median follow-up of 14 months after re-RT, the 1-year Kaplan-Meier estimates of post-re-RT progression-free survival (PFS) and overall survival (OS) were 42.8 and 61.8%, respectively. Univariate analysis identified histological grade at recurrence/progression; histological subtype; disease-free interval (DFI) and time interval between both courses of RT; performance status at re-RT; dose at re-RT and cumulative EQD2; isocitrate dehydrogenase (IDH) mutation; and O(6)-methyl-guanine DNA methyl transferase (MGMT) gene promoter methylation as significant prognostic factors. Preserved performance status, longer DFI, prolonged time interval between both courses of RT, and presence of IDH mutation were associated with significantly improved PFS on multi-variate analysis. However, only performance status retained independent prognostic significance for OS on multi-variate analysis. Post-treatment changes were seen in 33 (30%) patients on follow-up imaging, with higher cumulative dose (EQD2 >/= 104.3 Gy) being associated with increased risk of post-re-RT pseudo-progression. CONCLUSION: This clinical audit reports encouraging survival outcomes and identifies key prognostic factors associated with high-dose salvage re-RT in recurrent/progressive glioma. FAU - Gupta, T AU - Gupta T AUID- ORCID: 0000-0001-8256-9206 AD - Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India. tejpalgupta@rediffmail.com. FAU - Maitre, M AU - Maitre M AD - Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India. FAU - Maitre, P AU - Maitre P AD - Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India. FAU - Goda, J S AU - Goda JS AD - Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India. FAU - Krishnatry, R AU - Krishnatry R AD - Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India. FAU - Chatterjee, A AU - Chatterjee A AD - Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India. FAU - Moiyadi, A AU - Moiyadi A AD - Department of Neuro-Surgical Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India. FAU - Shetty, P AU - Shetty P AD - Department of Neuro-Surgical Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India. FAU - Epari, S AU - Epari S AD - Department of Pathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India. FAU - Sahay, A AU - Sahay A AD - Department of Pathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India. FAU - Patil, V AU - Patil V AD - Department of Medical Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India. FAU - Jalali, R AU - Jalali R AD - Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India. LA - eng PT - Journal Article DEP - 20210202 PL - Italy TA - Clin Transl Oncol JT - Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico JID - 101247119 SB - IM MH - Adolescent MH - Adult MH - Brain Neoplasms/*mortality/pathology/*radiotherapy MH - Disease Progression MH - Female MH - Glioma/*mortality/pathology/*radiotherapy MH - Humans MH - Male MH - Middle Aged MH - Neoplasm Recurrence, Local/*mortality/*radiotherapy MH - Prognosis MH - Radiotherapy Dosage MH - *Re-Irradiation/adverse effects/methods MH - Retrospective Studies MH - Salvage Therapy MH - Survival Rate MH - Treatment Outcome MH - Young Adult OTO - NOTNLM OT - Glioma OT - Prognostic OT - Re-irradiation OT - Recurrence OT - Salvage OT - Survival EDAT- 2021/02/03 06:00 MHDA- 2021/12/24 06:00 CRDT- 2021/02/02 12:15 PHST- 2020/10/24 00:00 [received] PHST- 2020/11/13 00:00 [accepted] PHST- 2021/02/03 06:00 [pubmed] PHST- 2021/12/24 06:00 [medline] PHST- 2021/02/02 12:15 [entrez] AID - 10.1007/s12094-020-02526-0 [pii] AID - 10.1007/s12094-020-02526-0 [doi] PST - ppublish SO - Clin Transl Oncol. 2021 Jul;23(7):1358-1367. doi: 10.1007/s12094-020-02526-0. Epub 2021 Feb 2.