Results of Treatment of Patients with Progression of Primary Highly Malignant Brain Gliomas During a Repeated Course of Radiation Therapy. Own Experience

Abstract

   Purpose: To determine the most effective option for repeated radiation therapy in patients with continued growth of primary high-grade brain glioma, taking into account the isodose distribution during the initial course of radiation therapy.   Material and methods: As a result of a retrospective analysis, the results of treatment of 100 patients with confirmed progression of high-grade glioma treated at the Chelyabinsk Regional Center for Oncology and Nuclear Medicine in the period from 2010 to 2020 were evaluated. The ratio of men and women was approximately equal (56 men and 44 women). The mean age of patients of both sexes was 47.2±11.9 years. According to the histological conclusion, patients with glioblastomas (GB) prevailed (n = 58), 42 patients were diagnosed with anaplastic astrocytoma (AA). Reoperation was performed in 26 patients. Repeated radiation therapy in an independent variant was performed in 76 patients of them: 17 patients received a course of neuronal therapy in mono mode and in 17 patients in combination with external beam radiation therapy; 23 patients underwent stereotactic radiotherapy (SRS) using the CyberKnife device; in 19 cases, remote radiation therapy. In 24 cases, a chemotherapeutic component was added in addition to radiation treatment.   Results: Mean time to relapse was 23 months. The median overall survival (OS) for all patients was 35 months. (DI 26.2–43.7). Indicators of 1-year OS — 85.6 %; 3-year-old — 44.1 %, 5-year-old — 26.5 %. Depending on the type of radiation therapy: the highest progression-free survival (PFS) was found with SPLT and combined photon-neutron therapy (SPNT) as in the group of patients with recurrent EH for 15, 17, and AA 24 and 40 months, respectively. Among the patients included in our study, the majority of patients (42 people) had central recurrences (in which 95 % or more of the volume of the recurrent tumor was within 100-95 % of the initial isodose), 6 had marginal relapses (20 to 80 % of the recurrent volume is within the surface of 95 % isodose), and in 2 cases a distant recurrence was recorded (less than 20 % of the recurrent volume was within 95 % of the isodose). Distant recurrences (marginal and distant) occurred within an average of 12 months, while central recurrences were diagnosed on average 26 months after the end of the course of radiation (chemoradiation) treatment.   Conclusion: Thus, when analyzing our data, in all patients with continued growth of primary high-grade brain gliomas, the method of choice for a repeated course of radiation therapy is stereotactic radiation therapy or a combined course of photon-neutron therapy, which allows to overcome the existing radioresistance.