PDF(Pubmed)
Abstract：
BACKGROUND: The optimal management strategy for recurrent glioblastoma (rGBM) remains uncertain, and the impact of re-irradiation (Re-RT) on overall survival (OS) is still a matter of debate. This study included patients who achieved gross total resection (GTR) after a second surgery after recurrence, following the GlioCave criteria.
METHODS: Inclusion criteria include being 18 years or older, having histologically confirmed locally recurrent IDHwt or IDH unknown GBM, achieving MRI-proven GTR after the second surgery, having a Karnofsky performance status of at least 60% after the second surgery, having a minimum interval of 6 months between the first radiotherapy and the second surgery, and a maximum of 8 weeks from second surgery to the start of Re-RT.
RESULTS: A total of 44 patients have met the inclusion criteria. The median OS after the second surgery was 14 months. All patients underwent standard treatment after initial diagnosis, including maximum safe resection, adjuvant radiochemotherapy and adjuvant chemotherapy. Re-RT did not significantly impact OS. However, MGMT promoter methylation status and a longer interval (> 12 months) between treatments were associated with better OS. Multivariate analysis revealed the MGMT status as the only significant predictor of OS.
CONCLUSIONS: Factors such as MGMT promoter methylation status and treatment interval play crucial roles in determining patient outcomes after second surgery. Personalized treatment strategies should consider these factors to optimize the management of rGBM. Prospective research is needed to define the value of re-RT after second surgery and to inform decision making in this situation.
METHODS: Inclusion criteria include being 18 years or older, having histologically confirmed locally recurrent IDHwt or IDH unknown GBM, achieving MRI-proven GTR after the second surgery, having a Karnofsky performance status of at least 60% after the second surgery, having a minimum interval of 6 months between the first radiotherapy and the second surgery, and a maximum of 8 weeks from second surgery to the start of Re-RT.
RESULTS: A total of 44 patients have met the inclusion criteria. The median OS after the second surgery was 14 months. All patients underwent standard treatment after initial diagnosis, including maximum safe resection, adjuvant radiochemotherapy and adjuvant chemotherapy. Re-RT did not significantly impact OS. However, MGMT promoter methylation status and a longer interval (> 12 months) between treatments were associated with better OS. Multivariate analysis revealed the MGMT status as the only significant predictor of OS.
CONCLUSIONS: Factors such as MGMT promoter methylation status and treatment interval play crucial roles in determining patient outcomes after second surgery. Personalized treatment strategies should consider these factors to optimize the management of rGBM. Prospective research is needed to define the value of re-RT after second surgery and to inform decision making in this situation.
摘要：
背景：复发性胶质母细胞瘤（rGBM）的最佳管理策略仍不确定，再照射（Re-RT）对总生存期（OS）的影响仍存在争议。这项研究包括复发后第二次手术后获得大体全切除（GTR）的患者，遵循GlioCave标准。
方法：纳入标准包括18岁或以上，经组织学证实局部复发性IDHwt或IDH未知GBM，第二次手术后获得MRI证实的GTR，在第二次手术后，Karnofsky的表现状态至少为60%，第一次放疗和第二次手术之间的最小间隔为6个月，从第二次手术到Re-RT开始的最长8周。
结果：共有44例患者符合纳入标准。第二次手术后的中位OS为14个月。所有患者在初步诊断后接受标准治疗，包括最大的安全切除,辅助放化疗和辅助化疗。Re-RT对OS没有显著影响。然而,MGMT启动子甲基化状态和治疗间隔时间较长（>12个月）与更好的OS相关。多变量分析显示MGMT状态是OS的唯一重要预测因子。
结论：MGMT启动子甲基化状态和治疗间隔等因素在决定患者二次手术后的预后中起着至关重要的作用。个性化治疗策略应考虑这些因素，以优化rGBM的管理。需要前瞻性研究来定义第二次手术后再RT的价值，并为这种情况下的决策提供信息。
方法：纳入标准包括18岁或以上，经组织学证实局部复发性IDHwt或IDH未知GBM，第二次手术后获得MRI证实的GTR，在第二次手术后，Karnofsky的表现状态至少为60%，第一次放疗和第二次手术之间的最小间隔为6个月，从第二次手术到Re-RT开始的最长8周。
结果：共有44例患者符合纳入标准。第二次手术后的中位OS为14个月。所有患者在初步诊断后接受标准治疗，包括最大的安全切除,辅助放化疗和辅助化疗。Re-RT对OS没有显著影响。然而,MGMT启动子甲基化状态和治疗间隔时间较长（>12个月）与更好的OS相关。多变量分析显示MGMT状态是OS的唯一重要预测因子。
结论：MGMT启动子甲基化状态和治疗间隔等因素在决定患者二次手术后的预后中起着至关重要的作用。个性化治疗策略应考虑这些因素，以优化rGBM的管理。需要前瞻性研究来定义第二次手术后再RT的价值，并为这种情况下的决策提供信息。
