Brain Re-irradiation for Recurrent Glioblastoma …. Is It Justified?

Main Article Content

Waleed N. Abozeed
Shimaa E. Attia
Mohamed S. Zahi


Background: Glioblastoma Multiforme (GBM) is a grade IV brain tumour with high recurrence rate despite maximum treatment including surgical resection, concurrent chemo-radiotherapy and adjuvant chemotherapy. In recurrent tumours, there is no standard treatment available.

Patients and Methods: This is a retrospective analysis of patients with recurrent GBM who presented to our department in the period between Jan 2017 to Dec 2018 and received re-irradiation after tumour recurrence. Data were collected from patient medical records to assess DFS, OAS and toxicity.

Results: Totally, 33 patients were enrolled. All cases were re-irradiated to a total dose of 30 Gy in 15 fractions. The overall survival and progression-free survival were significantly better in younger patients with good performance status and small tumour size. Only 2 cases (6.1%) developed deterioration of neurological symptoms.

Conclusion: Brain re-irradiation is a feasible and safe treatment option in patients with recurrent GBM.

A brain tumour, GBM, recurrence, re-irradiation.

Article Details

How to Cite
Abozeed, W. N., Attia, S. E., & Zahi, M. S. (2020). Brain Re-irradiation for Recurrent Glioblastoma …. Is It Justified?. International Research Journal of Oncology, 3(1), 1-8. Retrieved from
Original Research Article


Wen PY, Kesari S. Malignant gliomas in adults. N. Engl. J. Med. 2008;359:492- 507.

Stupp R, Mason WP, Van den Bent MJ, Weller M, Fisher B, Taphoorn M, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N. Engl. J. Med. 2005;352:987-996.

Nieder C, Adam M, Molls M, Grosu AL. Therapeutic options for recurrent high-grade glioma in adult patients: Recent advances. Crit. Rev. Oncol. Hematol. 2006;60:181-193.

Butowski NA, Sneed PK, Chang SM. Diagnosis and treatment of recurrent high-grade astrocytoma. J. Clin. Oncol. 2006; 24:1273-1280.

Thomas N. Seyfried, Laura Shelton, Gabriel Arismendi-Morillo, Miriam Kalamian, Ahmed Elsakka, Joseph Maroon. Provocative question: Should ketogenic metabolic therapy become the standard of care for glioblastoma? Mukherjee Neurochemical Research. 2019;44:2392–2404.

Patel M, Siddiqui F, Jin JY, Mikkelsen T, Rosenblum M, Movsas B, et al. Salvage reirradiation for recurrent glioblastoma with radiosurgery: Radiographic response and improved survival. J. Neurooncol. 2009; 92:185-191.

Mayer R, Sminia P. reirradiation tolerance of human brain. International Journal of Radiation Oncology, Biology, Physics. 2007;70(5):1350-1360.
DOI: 10.1016/j.ijrobp.2007.08.015

Sebastian F. Winter, Franziska Loebel, Jay Loeffler, Tracy T. Batchelor, Maria Martinez-Lage, Peter Vajkoczy. Treatment induced brain tissue necrosis: A clinical challenge in neuro-oncology. Dietrich Neuro-Oncology. 2019;21:1118–1130.

Combs SE, Edler L, Rausch R. Generation and validation of a prognostic score to predict outcome after re-irradiation of recurrent glioma. Acta Oncol. 2013; 52:147–52.

Seystahl K, Wick W, Weller M. Therapeutic options in recurrent glioblastoma: An update. Crit Rev Oncol Hematol. 2016; 99:389–408.

Shepherd SF, Laing RW, Cosgrove VP, Warrington AP, Hines F, Ashley SE, et al. Hypofractionated stereotactic radiotherapy in the management of recurrent glioma. Int J Radiat Oncol Biol Phys. 1997;37:393–398.

Gutin PH, Iwamoto FM, Beal K, Mohile NA, Karimi S, Hou BL, et al. Safety and efficacy of bevacizumab with hypofractionated stereotactic irradiation for recurrent malignant gliomas. Int J Radiat Oncol Biol Phys. 2009;75:156–163.

Fogh SE, Andrews DW, Glass J, Curran W, Glass C, Champ C, et al. Hypofractionated stereotactic radiation therapy: An effective therapy for recurrent high-grade gliomas. J Clin Oncol. 2010; 28:3048–3053.

Minniti G, Armosini V, Salvati M, Lanzetta G, Caporello P, Mei M, et al. Fractionated stereotactic reirradiation and concurrent temozolomide in patients with recurrent glioblastoma. J Neurooncol. 2011;103: 683–691.