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Purpose <p>Recurrent glioblastoma has a poor prognosis, and its optimal management remains unclear. Reirradiation (re-RT) is a promising treatment option, but long-term outcomes and optimal patient selection criteria are not well established.</p> Methods <p>This study analyzed 71 patients with recurrent CNS WHO grade 4, IDHwt glioblastoma (GBM) who underwent re-RT at the University of Erlangen-Nuremberg between January 2009 and June 2019. Imaging follow-ups were conducted every 3&#xa0;months. Progression-free survival (PFS) was defined using RANO criteria. Outcomes, feasibility, and toxicity of re-RT were evaluated. Contrast-enhancing tumor volume was measured using a deep learning auto-segmentation pipeline with expert validation and jointly evaluated with clinical and molecular-pathologic factors.</p> Results <p>Most patients were prescribed conventionally fractionated re-RT (84.5%) with 45&#xa0;Gy in 1.8&#xa0;Gy fractions, combined with temozolomide (TMZ, 49.3%) or lomustine (CCNU, 12.7%). Re-RT was completed as planned in 94.4% of patients. After a median follow-up of 73.8&#xa0;months, 88.7% of patients had died. The median overall survival was 9.6&#xa0;months, and the median progression-free survival was 5.3&#xa0;months. Multivariate analysis identified residual contrast-enhancing tumor volume at re-RT (HR 1.040 per cm<sup>3</sup>, p &lt; 0.001) as the single dominant predictor of overall survival.</p> Conclusion <p>Conventional fractionated re-RT is a feasible and effective treatment for recurrent high-grade glioma. The significant prognostic impact of residual tumor volume highlights the importance of combining maximum-safe resection with re-RT for improved outcomes.</p>

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Reirradiation for recurrent glioblastoma: the significance of the residual tumor volume

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月1日

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  • Sina Mansoorian,
  • Manuel Schmidt,
  • Thomas Weissmann,
  • Daniel Delev,
  • Dieter Henrik Heiland,
  • Roland Coras,
  • Jenny Stritzelberger,
  • Marc Saake,
  • Daniel Höfler,
  • Philipp Schubert,
  • Charlotte Schmitter,
  • Sebastian Lettmaier,
  • Irina Filimonova,
  • Benjamin Frey,
  • Udo S. Gaipl,
  • Luitpold V. Distel,
  • Sabine Semrau,
  • Christoph Bert,
  • Chukwuka Eze,
  • Stephan Schönecker,
  • Claus Belka,
  • Ingmar Blümcke,
  • Michael Uder,
  • Oliver Schnell,
  • Arnd Dörfler,
  • Rainer Fietkau,
  • Florian Putz

摘要

Purpose

Recurrent glioblastoma has a poor prognosis, and its optimal management remains unclear. Reirradiation (re-RT) is a promising treatment option, but long-term outcomes and optimal patient selection criteria are not well established.

Methods

This study analyzed 71 patients with recurrent CNS WHO grade 4, IDHwt glioblastoma (GBM) who underwent re-RT at the University of Erlangen-Nuremberg between January 2009 and June 2019. Imaging follow-ups were conducted every 3 months. Progression-free survival (PFS) was defined using RANO criteria. Outcomes, feasibility, and toxicity of re-RT were evaluated. Contrast-enhancing tumor volume was measured using a deep learning auto-segmentation pipeline with expert validation and jointly evaluated with clinical and molecular-pathologic factors.

Results

Most patients were prescribed conventionally fractionated re-RT (84.5%) with 45 Gy in 1.8 Gy fractions, combined with temozolomide (TMZ, 49.3%) or lomustine (CCNU, 12.7%). Re-RT was completed as planned in 94.4% of patients. After a median follow-up of 73.8 months, 88.7% of patients had died. The median overall survival was 9.6 months, and the median progression-free survival was 5.3 months. Multivariate analysis identified residual contrast-enhancing tumor volume at re-RT (HR 1.040 per cm3, p < 0.001) as the single dominant predictor of overall survival.

Conclusion

Conventional fractionated re-RT is a feasible and effective treatment for recurrent high-grade glioma. The significant prognostic impact of residual tumor volume highlights the importance of combining maximum-safe resection with re-RT for improved outcomes.