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Toxicity and efficacy of re-irradiation of high-grade glioma in a phase I dose- and volume escalation trial

Møller, Søren ; Munck af Rosenschöld, Per LU orcid ; Costa, Junia ; Law, Ian ; Poulsen, Hans Skovgaard ; Engelholm, Svend Aage and Engelholm, Silke (2017) In Radiotherapy and Oncology 125(2). p.223-227
Abstract

Introduction The purpose of this study was to evaluate the safety and efficacy of PET and MRI guided re-irradiation of recurrent high-grade glioma (HGG) and to assess the impact of radiotherapy dose, fractionation and irradiated volume. Material and methods Patients with localized, recurrent HGG (grades III-IV) and no other treatment options were eligible for a prospective phase I trial. Gross tumor volumes for radiotherapy were defined using T1-contrast enhanced MRI and 18F-fluoro-ethyl tyrosine PET. Radiotherapy was delivered using volumetric modulated arc therapy with a 2-mm margin. The dose prescription of four consecutive groups was (1) 35 Gy/10fr., (2) 42 Gy/10fr., (3) 29.5 Gy/5fr. and (4) 35 Gy/10fr. to larger tumor... (More)

Introduction The purpose of this study was to evaluate the safety and efficacy of PET and MRI guided re-irradiation of recurrent high-grade glioma (HGG) and to assess the impact of radiotherapy dose, fractionation and irradiated volume. Material and methods Patients with localized, recurrent HGG (grades III-IV) and no other treatment options were eligible for a prospective phase I trial. Gross tumor volumes for radiotherapy were defined using T1-contrast enhanced MRI and 18F-fluoro-ethyl tyrosine PET. Radiotherapy was delivered using volumetric modulated arc therapy with a 2-mm margin. The dose prescription of four consecutive groups was (1) 35 Gy/10fr., (2) 42 Gy/10fr., (3) 29.5 Gy/5fr. and (4) 35 Gy/10fr. to larger tumor volumes (100–300 cm3), respectively. Results Thirty-one patients were treated of which 81% had glioblastoma. The median progression-free survival was 2.8 months (95%CI: 2.1–3.5) and the median overall survival was 7.0 months (95%CI: 3.5–10.5). Early side effects were mild and included headache and fatigue. Seven patients were progression-free beyond 10 weeks and were evaluable for late toxicity. Among these patients, three (43%) suffered late adverse events which included radionecrosis and irreversible white matter changes. Conclusion Re-irradiation showed limited efficacy and 43% of patients achieving disease control suffered late toxicity that was manageable but not negligible.

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author
; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
keywords
High-grade glioma, phase I trial, Re-irradiation
in
Radiotherapy and Oncology
volume
125
issue
2
pages
5 pages
publisher
Elsevier
external identifiers
  • scopus:85031744921
  • pmid:29054380
ISSN
0167-8140
DOI
10.1016/j.radonc.2017.09.039
language
English
LU publication?
no
id
e6fba930-71a2-4337-b828-39c51b23f5c6
date added to LUP
2020-07-28 08:45:39
date last changed
2024-06-13 22:06:40
@article{e6fba930-71a2-4337-b828-39c51b23f5c6,
  abstract     = {{<p>Introduction The purpose of this study was to evaluate the safety and efficacy of PET and MRI guided re-irradiation of recurrent high-grade glioma (HGG) and to assess the impact of radiotherapy dose, fractionation and irradiated volume. Material and methods Patients with localized, recurrent HGG (grades III-IV) and no other treatment options were eligible for a prospective phase I trial. Gross tumor volumes for radiotherapy were defined using T1-contrast enhanced MRI and <sup>18</sup>F-fluoro-ethyl tyrosine PET. Radiotherapy was delivered using volumetric modulated arc therapy with a 2-mm margin. The dose prescription of four consecutive groups was (1) 35 Gy/10fr., (2) 42 Gy/10fr., (3) 29.5 Gy/5fr. and (4) 35 Gy/10fr. to larger tumor volumes (100–300 cm<sup>3</sup>), respectively. Results Thirty-one patients were treated of which 81% had glioblastoma. The median progression-free survival was 2.8 months (95%CI: 2.1–3.5) and the median overall survival was 7.0 months (95%CI: 3.5–10.5). Early side effects were mild and included headache and fatigue. Seven patients were progression-free beyond 10 weeks and were evaluable for late toxicity. Among these patients, three (43%) suffered late adverse events which included radionecrosis and irreversible white matter changes. Conclusion Re-irradiation showed limited efficacy and 43% of patients achieving disease control suffered late toxicity that was manageable but not negligible.</p>}},
  author       = {{Møller, Søren and Munck af Rosenschöld, Per and Costa, Junia and Law, Ian and Poulsen, Hans Skovgaard and Engelholm, Svend Aage and Engelholm, Silke}},
  issn         = {{0167-8140}},
  keywords     = {{High-grade glioma; phase I trial; Re-irradiation}},
  language     = {{eng}},
  month        = {{11}},
  number       = {{2}},
  pages        = {{223--227}},
  publisher    = {{Elsevier}},
  series       = {{Radiotherapy and Oncology}},
  title        = {{Toxicity and efficacy of re-irradiation of high-grade glioma in a phase I dose- and volume escalation trial}},
  url          = {{http://dx.doi.org/10.1016/j.radonc.2017.09.039}},
  doi          = {{10.1016/j.radonc.2017.09.039}},
  volume       = {{125}},
  year         = {{2017}},
}