Reirradiation of primary CNS tumors

Department of Radiation Oncology, London Regional Cancer Center, Ontario, Canada.
International Journal of Radiation OncologyBiologyPhysics (Impact Factor: 4.26). 10/1996; 36(2):433-41. DOI: 10.1016/S0360-3016(96)00315-X
Source: PubMed


Primary central nervous system (CNS) tumors are seldom reirradiated due to toxicity concerns and sparse clinical data regarding efficacy.
We retrospectively reviewed 34 patients with primary brain tumors retreated with fractionated external beam irradiation at the University of California, San Francisco from 1977-1993. Tumors included 15 medulloblastomas, 10 high-grade gliomas, 7 low-grade gliomas, and 2 meningiomas.
Initial course of radiation was radical in intent for all patients. Median age at initial diagnosis was 19.8 years (range: 3.6-67). Median interval between radiation courses was 16.3 months (range: 3.8-166). Median Karnofsky Performance Status (KPS) prior to reirradiation was 80 (range: 40-100). Reirradiation volumes overlapped previous treatment in 30 patients and were nonoverlapping in 4 patients. Fractionation schemes used were hyperfractionated in 17, conventionally fractionated in 9, and hypofractionated in 8. Cumulative maximum overlap dose within the CNS ranged from 43.2-111 Gy (median: 79.7 Gy). Retreatment was completed as planned in 27 out of 34 patients and modified or aborted in 7 (four tumor progression on retreatment, three patient request). As measured from the time of retreatment median progression free and overall survival was 3.3 and 8.3 months. Clinical and radiographic indices were stabilized or improved in about half of patients evaluable at a median of 3 months postretreatment. Complications (early or late) potentially attributable to retreatment were noted in 10 of 34 (29%) of patients. Overt necrosis was noted in 3 of 34 (9%) of patients and the actuarial risk of necrosis was 22% at 1 year following retreatment.
Reirradiation of primary central nervous system tumors was associated with only modest palliative and survival benefits in this retrospective review. Difficulties separating toxicity due to retreatment vs. tumor progression and limited patient survival following retreatment preclude definite conclusions regarding the safety of this practice.

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    • "In contrast to first-line radiotherapy where systematic efforts were undertaken to compare different fractionation regimens, no such randomized comparisons are available. The retrospective series reported by Bauman et al. (1996) included 17 patients with primary CNS tumors, who received hyperfractionated reirradiation and 17 patients treated with once-daily fractionation (Table 1). Some children, e.g., with medulloblastoma were included in this heterogeneous population. "
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    • "In the past, a second course of radiotherapy has been applied reluctantly with conventional techniques as treatment outcome outweighs the risk of treatment-related side effects [5]. With modern high-precision stereotactic photon techniques, such as Fractionated Stereotactic Radiotherapy (FSRT) re-irradiation could be established as a safe and effective treatment option for recurrent gliomas [6]. "
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