Introduction: Malignant gliomas are brain tumors deriving from the brain's glia cells. Primary treatment comprises resection, irradiation and chemotherapy, but these tumors almost always recur. In this situation, palliative chemotherapy is relatively well established, but a second local treatment is sometimes possible. We evaluated the safety and efficacy of re-irradiation in patients with recurrent malignant glioma.
Patients and methods: Twenty-two patients were treated with a second irradiation for recurrent or progressive glioma. Patients either received hypo-fractionated stereotactic treatment or conventionally fractionated conformal therapy, depending on tumor size. Wherever possible, a second resection was performed. Time to progression (TTP) and survival were estimated using the Kaplan-Meier product-limit method.
Results: Median age was 31 (8-77) years. Median TTP after onset of re-treatment was 4 (1-31) months. Median overall survival was 7 (1-46) months, and overall survival from primary diagnosis was 49 (7-136) months. Significantly longer TTP (P = 0.008) and overall survival (P = 0.005) were observed in re-resected patients than in those without a second surgical intervention.
Conclusion: Re-irradiation in malignant glioma is a feasible and safe treatment option, and the benefit appears to be especially large in re-resected patients. To make a final conclusion possible, larger prospective trials are warranted.