Abstract
BACKGROUND: Despite the improved results of treatment of brain tumors achieved over the past decade, most patients experience relapses of the disease 1–2 years after treatment. Numerous clinical studies have made it possible to obtain standard protocols for the treatment of primary brain tumors; however, protocols for the treatment of recurrent tumors have not been developed. The choice of treatment usually includes reoperation, systemic chemotherapy, and reirradiation alone or in combination. However, the treatment of recurrent glial tumors is challenging given the lack of effective treatment options and the lack of randomized controlled trials on which to base therapy.
AIM: To determine the most important prognostic factors, as well as the most effective treatment option in patients with continued growth of primary low-grade gliomas of the brain.
METHODS: This study included 40 patients with a confirmed diagnosis of progression of low-malignant glial brain tumors, who underwent inpatient treatment at the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine from 2007 to 2022. The ratio of men and women: 1:1.5. The mean age was 45.6±11.5 years. Patients with grade I astrocytomas predominated (n=23), oligodendroglioma was diagnosed in 8 patients.
Reoperation was performed in 11 patients as the first stage of progression treatment. In 7 cases, monochemotherapy with temozolomide was performed. Repeated radiation therapy was performed in 29 patients, of which: 9 patients received a course of combined photon-neutron therapy; 9 patients — stereotactic radiation therapy (was performed on the CyberKnife device); 11 patients — external beam radiation therapy.
RESULTS: The median overall survival (OS) for all patients with continued growth of low-grade cerebral gliomas after treatment was 120 months. 1-year OS — 97.3%; 3-year — 86.8%; 5-year — 78.2%. Median OS after relapse treatment was 36 months. The median OS was higher in the age group under 50 compared to the older age group: 120 and 95 months (p 0.05).
The best results of treatment were noted in patients who underwent reoperation followed by a course of radiation therapy or chemotherapy with temozolomide for 48 months and 36 months respectively (p 0.05). When analyzing the results of treatment after a course of repeated radiation therapy in an independent variant, there were undoubted advantages in patients who underwent stereotactic radiation therapy and photon-neutron therapy for 60 months and 24 months respectively (p 0.05).
CONCLUSIONS: The optimal approach to the treatment of patients with continued growth of primary low-grade glioma brain tumors is to perform a second operation, followed by radiation therapy or chemotherapy. The method of choice for a repeat course of radiotherapy may be photon-neutron therapy or stereotactic radiation therapy.