Reirradiation of large-volume recurrent glioma with pulsed reduced-dose-rate radiotherapy

Jarrod B. Adkison, Wolfgang A. Tome, Songwon Seo, Gregory M. Richards, H. Ian Robins, Karl Rassmussen, James S. Welsh, Peter A. Mahler, Steven P. Howard

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Purpose: Pulsed reduced-dose-rate radiotherapy (PRDR) is a reirradiation technique that reduces the effective dose rate and increases the treatment time, allowing sublethal damage repair during irradiation. Patients and Methods: A total of 103 patients with recurrent glioma underwent reirradiation using PRDR (86 considered to have Grade 4 at PRDR). PRDR was delivered using a series of 0.2-Gy pulses at 3-min intervals, creating an apparent dose rate of 0.0667 Gy/min to a median dose of 50 Gy (range, 20-60) delivered in 1.8-2.0-Gy fractions. The mean treatment volume was 403.5 ± 189.4 cm3 according to T2-weighted magnetic resonance imaging and a 2-cm margin. Results: For the initial or upgraded Grade 4 cohort (n = 86), the median interval from the first irradiation to PRDR was 14 months. Patients undergoing PRDR within 14 months of the first irradiation (n = 43) had a median survival of 21 weeks. Those treated ≥14 months after radiotherapy had a median survival of 28 weeks (n = 43; p = 0.004 and HR = 1.82 with a 95% CI ranging from 1.25 to 3.10). These data compared favorably to historical data sets, because only 16% of the patients were treated at first relapse (with 46% treated at the second relapse, 32% at the third or fourth relapse, and 4% at the fourth or fifth relapse). The median survival since diagnosis and retreatment was 6.3 years and 11.4 months for low-grade, 4.1 years and 5.6 months for Grade 3, and 1.6 years and 5.1 months for Grade 4 tumors, respectively, according to the initial histologic findings. Multivariate analysis revealed age at the initial diagnosis, initial low-grade disease, and Karnofsky performance score of ≥80 to be significant predictors of survival after initiation of PRDR. Conclusion: PRDR allowed for safe retreatment of larger volumes to high doses with palliative benefit.

Original languageEnglish (US)
Pages (from-to)835-841
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume79
Issue number3
DOIs
StatePublished - Mar 1 2011
Externally publishedYes

Fingerprint

Glioma
radiation therapy
Radiotherapy
dosage
grade
Recurrence
Retreatment
Survival
irradiation
Re-Irradiation
intervals
Multivariate Analysis
Magnetic Resonance Imaging
magnetic resonance
margins
tumors
Therapeutics
damage

Keywords

  • Pulsed reduced-dose-rate radiotherapy
  • Reirradiation
  • Transformed glioma

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Reirradiation of large-volume recurrent glioma with pulsed reduced-dose-rate radiotherapy. / Adkison, Jarrod B.; Tome, Wolfgang A.; Seo, Songwon; Richards, Gregory M.; Robins, H. Ian; Rassmussen, Karl; Welsh, James S.; Mahler, Peter A.; Howard, Steven P.

In: International Journal of Radiation Oncology Biology Physics, Vol. 79, No. 3, 01.03.2011, p. 835-841.

Research output: Contribution to journalArticle

Adkison, JB, Tome, WA, Seo, S, Richards, GM, Robins, HI, Rassmussen, K, Welsh, JS, Mahler, PA & Howard, SP 2011, 'Reirradiation of large-volume recurrent glioma with pulsed reduced-dose-rate radiotherapy', International Journal of Radiation Oncology Biology Physics, vol. 79, no. 3, pp. 835-841. https://doi.org/10.1016/j.ijrobp.2009.11.058
Adkison, Jarrod B. ; Tome, Wolfgang A. ; Seo, Songwon ; Richards, Gregory M. ; Robins, H. Ian ; Rassmussen, Karl ; Welsh, James S. ; Mahler, Peter A. ; Howard, Steven P. / Reirradiation of large-volume recurrent glioma with pulsed reduced-dose-rate radiotherapy. In: International Journal of Radiation Oncology Biology Physics. 2011 ; Vol. 79, No. 3. pp. 835-841.
@article{c388a245ba12488b9cf7f64b255977ab,
title = "Reirradiation of large-volume recurrent glioma with pulsed reduced-dose-rate radiotherapy",
abstract = "Purpose: Pulsed reduced-dose-rate radiotherapy (PRDR) is a reirradiation technique that reduces the effective dose rate and increases the treatment time, allowing sublethal damage repair during irradiation. Patients and Methods: A total of 103 patients with recurrent glioma underwent reirradiation using PRDR (86 considered to have Grade 4 at PRDR). PRDR was delivered using a series of 0.2-Gy pulses at 3-min intervals, creating an apparent dose rate of 0.0667 Gy/min to a median dose of 50 Gy (range, 20-60) delivered in 1.8-2.0-Gy fractions. The mean treatment volume was 403.5 ± 189.4 cm3 according to T2-weighted magnetic resonance imaging and a 2-cm margin. Results: For the initial or upgraded Grade 4 cohort (n = 86), the median interval from the first irradiation to PRDR was 14 months. Patients undergoing PRDR within 14 months of the first irradiation (n = 43) had a median survival of 21 weeks. Those treated ≥14 months after radiotherapy had a median survival of 28 weeks (n = 43; p = 0.004 and HR = 1.82 with a 95{\%} CI ranging from 1.25 to 3.10). These data compared favorably to historical data sets, because only 16{\%} of the patients were treated at first relapse (with 46{\%} treated at the second relapse, 32{\%} at the third or fourth relapse, and 4{\%} at the fourth or fifth relapse). The median survival since diagnosis and retreatment was 6.3 years and 11.4 months for low-grade, 4.1 years and 5.6 months for Grade 3, and 1.6 years and 5.1 months for Grade 4 tumors, respectively, according to the initial histologic findings. Multivariate analysis revealed age at the initial diagnosis, initial low-grade disease, and Karnofsky performance score of ≥80 to be significant predictors of survival after initiation of PRDR. Conclusion: PRDR allowed for safe retreatment of larger volumes to high doses with palliative benefit.",
keywords = "Pulsed reduced-dose-rate radiotherapy, Reirradiation, Transformed glioma",
author = "Adkison, {Jarrod B.} and Tome, {Wolfgang A.} and Songwon Seo and Richards, {Gregory M.} and Robins, {H. Ian} and Karl Rassmussen and Welsh, {James S.} and Mahler, {Peter A.} and Howard, {Steven P.}",
year = "2011",
month = "3",
day = "1",
doi = "10.1016/j.ijrobp.2009.11.058",
language = "English (US)",
volume = "79",
pages = "835--841",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Reirradiation of large-volume recurrent glioma with pulsed reduced-dose-rate radiotherapy

AU - Adkison, Jarrod B.

AU - Tome, Wolfgang A.

AU - Seo, Songwon

AU - Richards, Gregory M.

AU - Robins, H. Ian

AU - Rassmussen, Karl

AU - Welsh, James S.

AU - Mahler, Peter A.

AU - Howard, Steven P.

PY - 2011/3/1

Y1 - 2011/3/1

N2 - Purpose: Pulsed reduced-dose-rate radiotherapy (PRDR) is a reirradiation technique that reduces the effective dose rate and increases the treatment time, allowing sublethal damage repair during irradiation. Patients and Methods: A total of 103 patients with recurrent glioma underwent reirradiation using PRDR (86 considered to have Grade 4 at PRDR). PRDR was delivered using a series of 0.2-Gy pulses at 3-min intervals, creating an apparent dose rate of 0.0667 Gy/min to a median dose of 50 Gy (range, 20-60) delivered in 1.8-2.0-Gy fractions. The mean treatment volume was 403.5 ± 189.4 cm3 according to T2-weighted magnetic resonance imaging and a 2-cm margin. Results: For the initial or upgraded Grade 4 cohort (n = 86), the median interval from the first irradiation to PRDR was 14 months. Patients undergoing PRDR within 14 months of the first irradiation (n = 43) had a median survival of 21 weeks. Those treated ≥14 months after radiotherapy had a median survival of 28 weeks (n = 43; p = 0.004 and HR = 1.82 with a 95% CI ranging from 1.25 to 3.10). These data compared favorably to historical data sets, because only 16% of the patients were treated at first relapse (with 46% treated at the second relapse, 32% at the third or fourth relapse, and 4% at the fourth or fifth relapse). The median survival since diagnosis and retreatment was 6.3 years and 11.4 months for low-grade, 4.1 years and 5.6 months for Grade 3, and 1.6 years and 5.1 months for Grade 4 tumors, respectively, according to the initial histologic findings. Multivariate analysis revealed age at the initial diagnosis, initial low-grade disease, and Karnofsky performance score of ≥80 to be significant predictors of survival after initiation of PRDR. Conclusion: PRDR allowed for safe retreatment of larger volumes to high doses with palliative benefit.

AB - Purpose: Pulsed reduced-dose-rate radiotherapy (PRDR) is a reirradiation technique that reduces the effective dose rate and increases the treatment time, allowing sublethal damage repair during irradiation. Patients and Methods: A total of 103 patients with recurrent glioma underwent reirradiation using PRDR (86 considered to have Grade 4 at PRDR). PRDR was delivered using a series of 0.2-Gy pulses at 3-min intervals, creating an apparent dose rate of 0.0667 Gy/min to a median dose of 50 Gy (range, 20-60) delivered in 1.8-2.0-Gy fractions. The mean treatment volume was 403.5 ± 189.4 cm3 according to T2-weighted magnetic resonance imaging and a 2-cm margin. Results: For the initial or upgraded Grade 4 cohort (n = 86), the median interval from the first irradiation to PRDR was 14 months. Patients undergoing PRDR within 14 months of the first irradiation (n = 43) had a median survival of 21 weeks. Those treated ≥14 months after radiotherapy had a median survival of 28 weeks (n = 43; p = 0.004 and HR = 1.82 with a 95% CI ranging from 1.25 to 3.10). These data compared favorably to historical data sets, because only 16% of the patients were treated at first relapse (with 46% treated at the second relapse, 32% at the third or fourth relapse, and 4% at the fourth or fifth relapse). The median survival since diagnosis and retreatment was 6.3 years and 11.4 months for low-grade, 4.1 years and 5.6 months for Grade 3, and 1.6 years and 5.1 months for Grade 4 tumors, respectively, according to the initial histologic findings. Multivariate analysis revealed age at the initial diagnosis, initial low-grade disease, and Karnofsky performance score of ≥80 to be significant predictors of survival after initiation of PRDR. Conclusion: PRDR allowed for safe retreatment of larger volumes to high doses with palliative benefit.

KW - Pulsed reduced-dose-rate radiotherapy

KW - Reirradiation

KW - Transformed glioma

UR - http://www.scopus.com/inward/record.url?scp=79551488233&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79551488233&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2009.11.058

DO - 10.1016/j.ijrobp.2009.11.058

M3 - Article

C2 - 20472350

AN - SCOPUS:79551488233

VL - 79

SP - 835

EP - 841

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 3

ER -