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The role of radiotherapy in the management of progressive glioblastoma

A systematic review and evidence-based clinical practice guideline

  • TOPIC REVIEW & CLINICAL GUIDELINES
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Question

Can re-irradiation (by using conventional radiotherapy, fractionated radiosurgery, or single fraction radiosurgery) be used in patients with progressive glioblastoma multiforme after the first adjuvant combined multimodality treatment with radiation and chemotherapy?

Target population

These recommendations apply to adult patients with progressive glioblastoma after first line combined multimodality treatment with chemotherapy and radiation.

Recommendations

Level III

When the target tumor is amenable for additional radiation, re-irradiation is recommended as it provides improved local tumor control, as measured by best imaging response. Such re-irradiation can take the form of conventional fractionation radiotherapy, fractionated radiosurgery, or single fraction radiosurgery.

Level III

Re-irradiation is recommended in order to maintain or improve a patient’s neurological status and quality of life prior to any further tumor progression.

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Acknowledgments

We would like to acknowledge the AANS/CNS Joint Guidelines Committee for their review, comments and suggestions, the contributions of Laura Mitchell, CNS Guidelines Manager for organizational assistance, Maxine Brown for searching for and retrieving literature and Amy Allison for reference library consultations. We would also like to acknowledge the following individual JGC members for their contributions throughout the review process: Sepideh Amin-Hanjani, MD, FAANS, FACS, FAHA, Martina Stippler, MD, Alexander Khalessi, MD, Isabelle Germano, MD, Sean D. Christie, MD, FRCS (C), Gregory J. Zipfel, MD, Zachary Litvack, MD, MCR, Ann Marie Flannery, MD, Patricia B Raksin, MD, Joshua M. Rosenow, MD, FACS, Steven Casha, MD, PhD, Julie G. Pilitsis, MD, PhD, Gabriel Zada, MD, Adair Prall, Krystal Tomei, MD, Gregory W Hawryluk, MD.

Conflict of interest (COI)

Task Force members report potential COIs prior to beginning work on the guideline and at the time of publication. COI disclosures are reviewed by the Task Force Chair and taken into consideration when determining writing assignments. Resolution of potential COIs included Task Force members were assigned to chapters that did not involve or in any way relate to the potential COIs disclosed.

Disclaimer of liability

The information in these guidelines reflects the current state of knowledge at the time of completion. The presentations are designed to provide an accurate review of the subject matter covered. These guidelines are disseminated with the understanding that the recommendations by the authors and consultants who have collaborated in their development are not meant to replace the individualized care and treatment advice from a patient’s physician(s). If medical advice or assistance is required, the services of a physician should be sought. The proposals contained in these guidelines may not be suitable for use in all circumstances. The choice to implement any particular recommendation contained in these guidelines must be made by a managing physician in light of the situation in each particular patient and on the basis of existing resources.

Funding source

These guidelines were funded exclusively by the CNS and Tumor Section of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons whom received no funding from outside commercial sources to support the development of this document unless otherwise stated in this section.

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Authors and Affiliations

  1. Department of Radiation Oncology, Stony Brook University School of Medicine, Stony Brook, NY, USA

    Samuel Ryu

  2. Department of Radiation Oncology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA

    John M. Buatti & Ann Morris

  3. Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA

    Steven N. Kalkanis

  4. Department of Neurosurgery, Iowa Spine and Brain Institute and University of Iowa, Waterloo, Iowa City, IA, USA

    Timothy Charles Ryken

  5. Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA

    Jeffrey J. Olson

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Correspondence to Samuel Ryu.

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Ryu, S., Buatti, J.M., Morris, A. et al. The role of radiotherapy in the management of progressive glioblastoma. J Neurooncol 118, 489–499 (2014). https://doi.org/10.1007/s11060-013-1337-6

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