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Re-irradiation for recurrent glioblastoma (GBM): a systematic review and meta-analysis

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Abstract

Purpose

To determine the efficacy and toxicity of re-irradiation for patients with recurrent GBM.

Materials and methods

We searched various biomedical databases from 1998 to 2018, for eligible studies where patients were treated with re-irradiation for recurrent GBM. Outcomes of interest were 6 and 12-month overall survival (OS-6, OS-12), 6 and 12-month progression free survival (PFS-6, PFS-12) and serious (Grade 3 +) adverse events (AE). We used the random effects model to pool outcomes across studies and compared pre-defined subgroups using interaction test. Methodological quality of each study was assessed using the Newcastle-Ottawa scoring system.

Results

We found 50 eligible non-comparative studies including 2095 patients. Of these, 42% were of good or fair quality. The pooled results were as follows: OS-6 rate 73% (95% confidence interval (CI) 69–77%), OS-12 rate 36% (95% CI 32–40%), PFS-6 rate 43% (95% CI 35–50%), PFS-12 rate 17% (95% CI 13–20%), and Grade 3 + AE rate 7% (95% CI 4–10%). Subgroup analysis showed that prospective studies reported higher toxicity rates, and studies which utilized brachytherapy to have a longer OS-12. Within the external beam radiotherapy group, there was no dose–response [above or below 36 Gy in 2 Gy equivalent doses (EQD2)]. However, a short fractionation regimen (≤ 5 fractions) seemed to provide superior PFS-6.

Conclusion

The available evidence, albeit mostly level III, suggests that re-irradiation provides encouraging disease control and survival rates. Toxicity was not uniformly reported, but seemed to be low from the included studies. Randomized controlled trials (RCT) are needed to establish the optimal management strategy for recurrent GBM.

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Acknowledgements

We thank Senior Librarian (National University of Singapore, Medical Library), Ms Annelissa Chin, for assisting with the literature review and search strategy.

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  1. Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore, 119228, Singapore

    Farasat Kazmi, Yu Yang Soon, Yiat Horng Leong, Wee Yao Koh & Balamurugan Vellayappan

  2. Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore

    Balamurugan Vellayappan

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  1. Farasat Kazmi
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Kazmi, F., Soon, Y.Y., Leong, Y.H. et al. Re-irradiation for recurrent glioblastoma (GBM): a systematic review and meta-analysis. J Neurooncol 142, 79–90 (2019). https://doi.org/10.1007/s11060-018-03064-0

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