High-dose salvage re-irradiation in recurrent/progressive adult diffuse gliomas: development of a novel prognostic scoring system.

Abstract

PURPOSE:

Over the past two decades, high-dose salvage re-irradiation (re-RT) has been used increasingly in the multimodality management of adults with recurrent/progressive diffuse glioma. Several factors that determine outcomes following re-RT have been incorporated into prognostic models to guide patient selection. We aimed to develop a novel four-tiered prognostic model incorporating relevant molecular markers from our single-institutional cohort of patients treated with high-dose salvage re-RT for recurrent/progressive diffuse glioma.

MATERIAL AND METHODS:

Various patient, disease, and treatment-related factors impacting upon survival following salvage re-RT were identified through univariate analysis. Each of these prognostic factors was further subdivided and assigned scores of 0 (low-risk), 1 (intermediate-risk), or 2 (high-risk). Scores from individual prognostic factors were added to derive the cumulative score (ranging from 0 to 16), with increasing scores indicating worsening prognosis.

RESULTS:

A total of 111 adults with recurrent/progressive diffuse glioma treated with salvage high-dose re-RT were included. We could assign patients into four prognostic subgroups (A=15 patients, score 0-3); (B=50 patients, score 4-7); (C=33 patients, score 8-10); and (D=13 patients, score 11-16) with completely non-overlapping survival curves suggesting the good discriminatory ability. Post-re-RT survival was significantly higher in Group A compared to groups B, C, and D, respectively (stratified log-rank p-value <0.0001).

CONCLUSION:

There exists a lack of universally acceptable 'standard-of-care' salvage therapy for recurrent/progressive diffuse glioma. A novel four-tiered prognostic scoring system incorporating traditional factors as well as relevant molecular markers is proposed for selecting patients appropriately for high-dose salvage re-RT that warrants validation in a non-overlapping cohort.

• Authors: M Maitre, T Gupta, P Maitre, A Chatterjee, A Dasgupta, A Moiyadi, P Shetty, S Epari, A Sahay, V Patil, R Krishnatry, G J Sastri, R Jalali
• Journal: Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique (Cancer Radiother) Vol. 26 Issue 8 Pg. 994-1001 (Nov 2022) ISSN: 1769-6658 [Electronic] France
• PMID: 35715356 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

Topics

• Adult
• Humans
• Re-Irradiation
• Salvage Therapy
• Prognosis
• Brain Neoplasms (radiotherapy)
• Neoplasm Recurrence, Local (radiotherapy)
• Glioma (therapy)