Stereotactic Reirradiation Strategies for Recurrent High-Grade Gliomas
Summary
Recurrent high-grade gliomas pose a formidable challenge owing to their infiltrative growth, resistance to salvage therapies and proximity to critical brain structures. Stereotactic reirradiation has emerged as a precision-based modality that delivers conformal high doses to residual or recurrent tumour while sparing surrounding healthy tissue. Techniques range from single-fraction stereotactic radiosurgery to hypofractionated or normo-fractionated stereotactic radiotherapy, selected according to tumour volume, location and prior dose distributions. Advanced imaging, including contrast-enhanced MRI and amino-acid PET, guides delineation of gross tumour volume and allows for millimetre-scale accuracy in defining planning target volumes. Contemporary practice integrates reirradiation with systemic agents—particularly alkylating chemotherapy and anti-angiogenic antibodies—to potentiate local control and delay progression. Prognostic factors such as performance status, interval since initial radiotherapy and molecular markers inform patient selection. Cumulative dose constraints, often expressed as equivalent dose in 2 Gy fractions (EQD2), are carefully managed to minimise radionecrosis. As technology advances, adaptive planning and real-time image guidance promise to refine dose delivery further, widening the therapeutic window. International series report median post-reirradiation survival extending beyond nine months, underscoring global relevance and potential to standardise salvage care across centres.
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Stereotactic Reirradiation Strategies for Recurrent High-Grade Gliomas publication trend
The graph below shows the total number of articles in stereotactic reirradiation strategies for recurrent high-grade gliomas across all publications each year (not limited to Nature Index journals).
Technical terms
Stereotactic radiosurgery (SRS): Delivery of a single high-dose radiation fraction with submillimetre accuracy to a defined target volume.
Stereotactic radiotherapy (SRT): Fractionated focal radiation delivered over multiple sessions, employing stereotactic localisation for precision.
Hypofractionation: Radiation schedule using larger doses per fraction over fewer sessions to intensify tumour dose while limiting overall treatment time.
Normo-fractionated reirradiation: Use of conventional dose per fraction (∼2 Gy) in a second course of focal radiotherapy.
Planning target volume (PTV): Tissue volume encompassing the gross tumour plus a margin to account for motion and setup uncertainties.
Equivalent dose in 2 Gy fractions (EQD2): Radiobiological metric enabling comparison of different fractionation regimens by normalising to 2 Gy per fraction.
References
- The efficacy of stereotactic radiotherapy followed by bevacizumab and temozolomide in the treatment of recurrent glioblastoma: a case report. Frontiers in Pharmacology (2024).
- Efficacy and Low Toxicity of Normo-Fractionated Re-Irradiation with Combined Chemotherapy for Recurrent Glioblastoma—An Analysis of Treatment Response and Failure. Cancers (2024).
- Current status and recent advances in reirradiation of glioblastoma. Radiation Oncology (2021).
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