Impact of surgical treatment on the performance status of patients with high-grade gliomas

2020 ◽  
Vol 42 (12) ◽  
pp. 1074-1079
Author(s):  
Nikolay Gabrovsky ◽  
Maria Laleva ◽  
George Poptodorov ◽  
Nikolay Velinov ◽  
Margarita Kamenova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Performance Status ◽  
High Grade ◽  
High Grade Gliomas

scholarly journals Bevacizumab in recurrent high-grade glioma: a single institution retrospective analysis on 92 patients

2021 ◽  
Author(s):  
Beatrice Detti ◽  
Silvia Scoccianti ◽  
Maria Ausilia Teriaca ◽  
Virginia Maragna ◽  
Victoria Lorenzetti ◽  
...  
Keyword(s):  
Recurrent Disease ◽  
Performance Status ◽  
High Grade Glioma ◽  
Recurrent Glioblastoma ◽  
High Grade ◽  
Two Phase ◽  
Primary Tumors ◽  
Entire Cohort ◽  
Bevacizumab Treatment ◽  
High Grade Gliomas

Abstract Background High-grade gliomas are among the most aggressive central nervous system primary tumors, with a high risk of recurrence and a poor prognosis. Re-operation, re-irradiation, chemotherapy are options in this setting. No-best therapy has been established. Bevacizumab was approved on the basis of two Phase 2 trials that evaluated its efficacy in patients with recurrent glioblastoma. Materials and methods We have retrospectively review data of patients with high-grade glioma treated at our institution that undergone radiological or histological progression after at least one systemic treatment for recurrent disease. Bevacizumab was administered alone or in combination with chemotherapy until disease progression or unacceptable toxicity. Bevacizumab regimen was analyzed to assess PFS and OS. Histological, molecular and clinical features of the entire cohort were collected. Results We reviewed data from 92 patients, treated from April 2009 to November 2019, with histologically confirmed diagnosis of high-grade gliomas and recurrent disease. A PFS of 55.2%, 22.9% and 9.6% was observed at 6, 12 and 24 months, respectively. Performance status, age at diagnosis (< 65 or > 65 ys.) and use of corticosteroids during bevacizumab therapy were strongly associated with PFS. The OS was 74.9% at 6 months, 31.7% at 12 months, 10.1% at 24 months. In our cohort, 51.1% were long-term responders (PFS > 6 months). Globally, bevacizumab treatment was well tolerated. Conclusion Our analysis confirms the efficacy of bevacizumab in recurrent high-grade glioma patients with an acceptable toxicity profile, in keeping with its known safety in the literature.

Policies for reirradiation of recurrent high-grade gliomas: a survey among Italian radiation oncologists

2018 ◽  
Vol 104 (6) ◽  
pp. 466-470
Author(s):  
Carlo Furlan ◽  
Stefano Arcangeli ◽  
Michele Avanzo ◽  
Maria A. Mirri ◽  
Fernando Munoz ◽  
...  
Keyword(s):  
Performance Status ◽  
Collaborative Study ◽  
Study Groups ◽  
High Grade ◽  
Private Institutions ◽  
Online Questionnaire ◽  
Radiation Oncologists ◽  
Academic Hospitals ◽  
The Central Nervous System ◽  
High Grade Gliomas

Purpose: To assess the contribution of Italian radiation oncologists in the current management of recurrent high-grade gliomas (HGG), focusing on a reirradiation (reRT) approach. Methods: In 2015, the Reirradiation and the Central Nervous System Study Groups on behalf of the Italian Association of Radiation Oncology (AIRO) proposed a survey. All Italian radiation oncologists were individually invited to complete an online questionnaire regarding their clinical management of recurrent HGG, focusing on a reRT approach. Results: A total of 37 of 210 questionnaires were returned (18% of all centers): 16 (43%) from nonacademic hospitals, 14 (38%) from academic hospitals, 5 (13%) from private institutions, and 2 (6%) from hadron therapy centers. The majority of responding centers (59%) treated ≤5 cases per year. Performance status at the time of recurrence, along with a target diameter <5 cm and an interval from primary radiation ≥6 months, were the prevalent predictive factors considered for reRT. Sixty percent of reirradiated patients had already received a salvage therapy, either chemotherapy (40%) or reoperation (20%). The most common approach for reRT was fractionated stereotactic radiotherapy to a mean (photon) dose of 41.6 Gy. Conclusions: Although there were wide variations in the clinical practice of reRT across the 37 centers, the core activities were reasonably consistent. These findings provide a basis for encouraging a national collaborative study to develop, implement, and monitor the use of reRT in this challenging clinical setting.

scholarly journals Safety and Efficacy of Hypofractionated Stereotactic Radiosurgery for High-Grade Gliomas at First Recurrence: A Single-Center Experience

2020 ◽  
Author(s):  
Yun Guan ◽  
Ji Xiong ◽  
Mingyuan Pan ◽  
Wenyin Shi ◽  
Jing Li ◽  
...  
Keyword(s):  
Planning Target Volume ◽  
Performance Status ◽  
Target Volume ◽  
Salvage Treatment ◽  
High Grade ◽  
Who Grade ◽  
Cyberknife Radiosurgery ◽  
High Grade Gliomas ◽  
First Recurrence ◽  
Grade 3

Abstract Background: The optimal treatment for recurrent high-grade gliomas (rHGG) remains uncertain. This research aimed to investigate the efficacy and safety of CyberKnife radiosurgery as a salvage treatment for high-grade gliomas at first recurrence that within the radiation field.Methods: Between January 2016 and October 2019, rHGG patients treated with CyberKnife radiosurgery were retrospectively analyzed. The primary endpoint was OS, and secondary endpoints included progression-free survival (PFS) and toxicity. Toxicity was assessed using CTCAE 5.0. The prognostic value of key clinical features (age, performance status, planning target volume, dose, use of bevacizumab) were evaluated.Results: A total of 70 patients were included in the study. Forty patients were male and 30 were female. Forty-nine had an initial diagnosis Glioblastoma (GBM), and rest (21) were WHO Grade 3 Gliomas. The median planning target volume (PTV) was 16.68 cm3 (0.81–121.96 cm3). The median prescribed dose was 24 Gy (12-30 Gy) in 4 fractions (2-6 fractions). Median baseline Karnofsky Performance Status (KPS) is 70 (40-90). With a median follow-up of 12.1 months, the median overall survival after salvage treatment was 17.6 months (19.5 and 14.6 months for grade 3 and 4 gliomas; p = 0.039). No grade 3 or higher toxicities was recorded. Multivariate analysis showed concurrent bevacizumab with radiosurgery and KPS>70 were favorable prognostic factors for grade 4 patients.Conclusions: Salvage CyberKnife radiosurgery showed a favorable outcome and acceptable toxicity for rHGG. A prospective phase II study (NCT04197492) is ongoing to further investigate the value of HSRS in rHGG.

scholarly journals P17.27 * HIGH GRADE GLIOMAS IN ELDERLY PATIENTS: RESULTS OF SURGERY AND INFLUENCE ON KARNOFSKY'S PERFORMANCE STATUS

2014 ◽  
Vol 16 (suppl 2) ◽  
pp. ii93-ii93
Author(s):  
A. Agnoletti ◽  
R. Fornaro ◽  
F. M. C. Specchia ◽  
D. Garbossa ◽  
M. Lanotte ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Performance Status ◽  
High Grade ◽  
High Grade Gliomas ◽  
Results Of Surgery

scholarly journals Safety and efficacy of Hypofractionated stereotactic radiosurgery for high-grade Gliomas at first recurrence: a single-center experience

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yun Guan ◽  
Ji Xiong ◽  
Mingyuan Pan ◽  
Wenyin Shi ◽  
Jing Li ◽  
...  
Keyword(s):  
Overall Survival ◽  
Adverse Events ◽  
Stereotactic Radiosurgery ◽  
Performance Status ◽  
Target Volume ◽  
Salvage Treatment ◽  
High Grade ◽  
High Grade Gliomas ◽  
Grade 3 ◽  
Hypofractionated Stereotactic Radiosurgery

Abstract Background The optimal treatment for recurrent high-grade gliomas (rHGGs) remains uncertain. This study aimed to investigate the efficacy and safety of hypofractionated stereotactic radiosurgery (HSRS) as a first-line salvage treatment for in-field recurrence of high-grade gliomas. Methods Between January 2016 and October 2019, 70 patients with rHGG who underwent HSRS were retrospectively analysed. The primary endpoint was overall survival (OS), and secondary endpoints included both progression-free survival (PFS) and adverse events, which were assessed according to Common Toxicity Criteria Adverse Events (CTCAE) version 5. The prognostic value of key clinical features (age, performance status, planning target volume, dose, use of bevacizumab) was evaluated. Results A total of 70 patients were included in the study. Forty patients were male and 30 were female. Forty-nine had an initial diagnosis of glioblastoma (GBM), and the rest (21) were confirmed to be WHO grade 3 gliomas. The median planning target volume (PTV) was 16.68 cm3 (0.81–121.96 cm3). The median prescribed dose was 24 Gy (12–30 Gy) in 4 fractions (2–6 fractions). The median baseline of Karnofsky Performance Status (KPS) was 70 (40–90). With a median follow-up of 12.1 months, the median overall survival after salvage treatment was 17.6 months (19.5 and 14.6 months for grade 3 and 4 gliomas, respectively; p = .039). No grade 3 or higher toxicities was recorded. Multivariate analysis showed that concurrent bevacizumab with radiosurgery and KPS > 70 were favourable prognostic factors for grade 4 patients with HGG. Conclusions Salvage HSRS showed a favourable outcome and acceptable toxicity for rHGG. A prospective phase II study (NCT04197492) is ongoing to further investigate the value of hypofractionated stereotactic radiosurgery (HSRS) in rHGG.

scholarly journals Safety and Efficacy of Hypofractionated Stereotactic Radiosurgery for High-Grade Gliomas at First Recurrence: A Single-Center Experience

2020 ◽  
Author(s):  
Yun Guan ◽  
Ji Xiong ◽  
Mingyuan Pan ◽  
Wenyin Shi ◽  
Jing Li ◽  
...  
Keyword(s):  
Overall Survival ◽  
Adverse Events ◽  
Performance Status ◽  
Target Volume ◽  
Salvage Treatment ◽  
High Grade ◽  
Cyberknife Radiosurgery ◽  
High Grade Gliomas ◽  
Grade 3 ◽  
Hypofractionated Stereotactic Radiosurgery

Abstract Background: The optimal treatment for recurrent high-grade gliomas (rHGG) remains uncertain. This study aimed to investigate the efficacy and safety of CyberKnife radiosurgery as a salvage treatment for in field recurrence of high-grade gliomas at first time.Methods: Between January 2016 and October 2019, seventy patients with rHGG undergone CyberKnife radiosurgery were retrospectively analyzed. The primary endpoint was overall survival (OS), and secondary endpoints included both progression-free survival (PFS) and adverse events which was according to Common Toxicity Criteria Adverse Events (CTCAE) version 5. The prognostic value of key clinical features (age, performance status, planning target volume, dose, use of bevacizumab) were evaluated.Results: A total of 70 patients were included in the study. Forty patients were male and 30 were female. Forty-nine had an initial diagnosis of glioblastoma (GBM), and the rest (21) were confirmed to be WHO grade 3 gliomas. The median planning target volume (PTV) was 16.68 cm3 (0.81 – 121.96 cm3). The median prescribed dose was 24 Gy (12-30 Gy) in 4 fractions (2-6 fractions). Median baseline of Karnofsky Performance Status (KPS) is 70 (40 - 90). With a median follow-up of 12.1 months, the median overall survival after salvage treatment was 17.6 months (19.5 and 14.6 months for grade 3 and 4 gliomas respectively; p = .039). No grade 3 or higher toxicities was recorded. Multivariate analysis showed that concurrent bevacizumab with radiosurgery and KPS>70 were favorable prognostic factors for grade 4 patients with HGG.Conclusions: Salvage CyberKnife radiosurgery showed a favorable outcome and acceptable toxicity for rHGG. A prospective phase II study (NCT04197492) is ongoing to further investigate the value of hypofractionated stereotactic radiosurgery (HSRS) in rHGG.

Surgical treatment of high-grade gliomas in motor areas. The impact of different supportive technologies: a 171-patient series

2010 ◽  
Vol 100 (3) ◽  
pp. 417-426 ◽  
Author(s):  
Andrea Talacchi ◽  
Sergio Turazzi ◽  
Francesca Locatelli ◽  
Francesco Sala ◽  
Alberto Beltramello ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
High Grade ◽  
Patient Series ◽  
High Grade Gliomas ◽  
The Impact ◽  
Motor Areas

scholarly journals Spinal Cord Stimulation as Adjuvant During Chemotherapy and Reirradiation Treatment of Recurrent High-Grade Gliomas

2014 ◽  
Vol 13 (6) ◽  
pp. 513-519 ◽  
Author(s):  
Bernardino Clavo ◽  
Francisco Robaina ◽  
Ignacio J. Jorge ◽  
Raquel Cabrera ◽  
Eugenio Ruiz-Egea ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Overall Survival ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
Performance Status ◽  
Tumor Hypoxia ◽  
High Grade ◽  
Median Dose ◽  
Anaplastic Gliomas ◽  
High Grade Gliomas

Aims. Relapsed high-grade gliomas (HGGs) have poor prognoses and there is no standard treatment. HGGs have ischemia/hypoxia associated and, as such, drugs and oxygen have low access, with increased resistance to chemotherapy and radiotherapy. Tumor hypoxia modification can improve outcomes and overall survival in some patients with these tumors. In previous works, we have described that cervical spinal cord stimulation can modify tumor microenvironment in HGG by increasing tumor blood flow, oxygenation, and metabolism. The aim of this current, preliminary, nonrandomized, study was to assess the clinical effect of spinal cord stimulation during brain reirradiation and chemotherapy deployed for the treatment of recurrent HGG; the hypothesis being that an improvement in oxygenated blood supply would facilitate enhanced delivery of the scheduled therapy. Materials and methods. Seven patients had spinal cord stimulation applied during the scheduled reirradiation and chemotherapy for the treatment of recurrent HGG (6 anaplastic gliomas and 1 glioblastoma). Median dose of previous irradiation was 60 Gy (range = 56-72 Gy) and median dose of reirradiation was 46 Gy (range = 40-46 Gy). Primary end point of the study was overall survival (OS) following confirmation of HGG relapse. Results. From the time of diagnosis of last tumor relapse before reirradiation, median OS was 39 months (95% CI = 0-93) for the overall study group: 39 months (95% CI = 9-69) for those with anaplastic gliomas and 16 months for the patient with glioblastoma. Posttreatment, doses of corticosteroids was significantly decreased ( P = .026) and performance status significantly improved ( P = .046). Conclusions. Spinal cord stimulation during reirradiation and chemotherapy is feasible and well tolerated. In our study, spinal cord stimulation was associated with clinical improvement and longer survival than previously reported in recurrent anaplastic gliomas. Spinal cord stimulation as adjuvant during chemotherapy and reirradiation in relapsed HGGs merits further research.

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