Purpose

We aimed to evaluate the prognostic factors and the role of stereotactic radiotherapy (SRT) as a re-irradiation technique in the management of progressive glioblastoma.

Methods

The records of 77 previously irradiated glioblastoma patients who progressed and received second course hypofractionated SRT (1–5 fractions) between 2009 and 2022 in our department were evaluated retrospectively. Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM, Armonk, NY, USA) was utilized for all statistical analyses.

Results

The median time to progression from the end of initial radiotherapy was 14 months (range, 6–68 months). The most common SRT schedule was 30 Gy (range, 18–50 Gy) in 5 fractions (range, 1–5 fractions). The median follow-up after SRT was 9 months (range, 3–80 months). One-year overall (OS) and progression-free survival (PFS) rates after SRT were 46% and 35%, respectively. Re-irradiation dose and the presence of pseudoprogression were both significant independent positive prognostic factors for both OS (p = 0.009 and p = 0.04, respectively) and PFS (p = 0.008 and p = 0.04, respectively). For PFS, progression-free interval > 14 months was also a prognostic factor (p = 0.04). The treatment was well tolerated without significant acute toxicity. During follow-up, radiation necrosis was observed in 17 patients (22%), and 14 (82%) of them were asymptomatic.

Conclusion

Hypofractionated SRT is an effective treatment approach for patients with progressive glioblastoma. Younger patients who progressed later than 14 months, received higher SRT doses, and experienced pseudoprogression following SRT had improved survival rates.

中文翻译：

---

大分割立体定向再照射治疗进展性胶质母细胞瘤：单中心十二年经验

目的

我们的目的是评估预后因素以及立体定向放射治疗（SRT）作为再照射技术在进展性胶质母细胞瘤治疗中的作用。

方法

我们对 2009 年至 2022 年间 77 名既往接受过放射治疗的胶质母细胞瘤患者病情进展并接受二程大分割 SRT（1-5 次）的记录进行了回顾性评估。所有统计分析均使用社会科学统计软件包 (SPSS) 23.0 版（IBM，美国纽约州阿蒙克）。

结果

从初始放疗结束到进展的中位时间为 14 个月（范围 6-68 个月）。最常见的 SRT 计划是 30 Gy（范围，18-50 Gy），分 5 次（范围，1-5 次）。SRT 后的中位随访时间为 9 个月（范围：3-80 个月）。SRT 后的一年总体 (OS) 和无进展生存 (PFS) 率分别为 46% 和 35%。对于 OS（分别为p  = 0.009 和p  = 0.04）和 PFS（分别为p  = 0.008 和p  = 0.04），再照射剂量和假性进展的存在都是显着的独立阳性预后因素。对于 PFS，无进展间隔 > 14 个月也是一个预后因素 ( p  = 0.04)。该治疗耐受性良好，没有明显的急性毒性。随访期间，17例（22%）患者出现放射性坏死，其中14例（82%）无症状。

结论

大分割SRT是治疗进展性胶质母细胞瘤患者的有效方法。病情进展晚于 14 个月、接受较高 SRT 剂量以及 SRT 后出现假性进展的年轻患者的生存率有所提高。