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Reirradiation of recurrent glioblastoma: Results from a single-center retrospective cohort study.

Clinical and translational radiation oncology

Authors: Cas S Dejonckheere, Thomas Zeyen, Cathrina Duffy, Yannik C Layer, Anna-Laura Potthoff, Barbara D Wichtmann, Lea L Friker, Davide Scafa, Christina Leitzen, Younèss Nour, Fabian Kugel, Niklas Schäfer, Alexander Radbruch, Hartmut Vatter, Anca-Ligia Grosu, Ulrich Herrlinger, Matthias Schneider, Frank A Giordano, Gustavo R Sarria, Eleni Gkika, Julian P Layer

PURPOSE: The management of recurrent glioblastoma (rGBM) remains a clinical challenge, with only limited therapeutic options available to date. Reirradiation may offer a progression-free survival (PFS) benefit in selected cases, but data are scarce.

METHODS: Consecutive patients from the last 10 years with GBM (CNS WHO grade 4, IDH-wildtype) who underwent at least one additional course of cranial radiotherapy for suspected or histopathologically confirmed rGBM at a tertiary neuro-oncological center were retrospectively analyzed. The primary endpoint was PFS, secondary endpoints included reirradiation-related adverse event rates, with a particular focus on radiation necrosis (RN).

RESULTS: Fifty-nine patients were included with a median follow-up (range) of 8.7 (0.5-48.0) months after reirradiation. The median time to first recurrence was 15 (4-89) months, with the majority occurring in-field (59.7 %). The EQD2 ranged from 31.3-80.2 Gy with a median prescription dose of 42 Gy. Reirradiation was combined with systemic therapy in 81.4 % of patients. No grade 3-5 acute reirradiation-related adverse events were observed. RN was diagnosed in 16.9 % of patients (80 % grade 2 and 20 % grade 3), with a notably low rate in those receiving anti-VEGF therapy parallel to reirradiation. RN risk was independent of reirradiation volume or dose ( = 0.15 and 0.43, respectively). The disease control rate following reirradiation was 83.6 % and the median PFS was 5.9 (0.5-48.0) months. Concomitant chemotherapy or anti-VEGF therapy was significantly associated with improved outcomes ( = 0.049), whereas smaller reirradiation volumes demonstrated a non-significant trend towards longer PFS ( = 0.23).

CONCLUSION: In this retrospective analysis, reirradiation for rGBM was feasible and safe, conferring a potential PFS benefit in selected patients. Bevacizumab emerged as a particularly promising combination partner, contributing to both RN prevention and enhanced efficacy.

© 2025 The Author(s).

PMID: 40821395

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