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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Sep 24, 2021; 12(9): 767-786
Published online Sep 24, 2021. doi: 10.5306/wjco.v12.i9.767
Re-irradiation for high-grade gliomas: Has anything changed?
Sonia García-Cabezas, Eleonor Rivin del Campo, Juan Solivera-Vela, Amalia Palacios-Eito
Sonia García-Cabezas, Amalia Palacios-Eito, Department of Radiation Oncology, Reina Sofia University Hospital, Cordoba 14004, Spain
Eleonor Rivin del Campo, Department of Radiation Oncology, Tenon University Hospital, Paris 75020, France
Juan Solivera-Vela, Department of Neurosurgery, Reina Sofia University Hospital, Cordoba 14004, Spain
Author contributions: All authors contributed to the writing and revision of this manuscript.
Conflict-of-interest statement: The authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amalia Palacios-Eito, MD, PhD, Associate Professor, Chief Doctor, Department of Radiation Oncology, Reina Sofia University Hospital, Avda. Menéndez Pidal, s/n, Cordoba 14004, Spain. amalia.palacios.sspa@juntadeandalucia.es
Received: June 2, 2021
Peer-review started: June 2, 2021
First decision: July 16, 2021
Revised: July 21, 2021
Accepted: July 30, 2021
Article in press: July 30, 2021
Published online: September 24, 2021
Processing time: 106 Days and 15 Hours
Abstract

Optimal management after recurrence or progression of high-grade gliomas is still undefined and remains a challenge for neuro-oncology multidisciplinary teams. Improved radiation therapy techniques, new imaging methods, published experience, and a better radiobiological knowledge of brain tissue have positioned re-irradiation (re-RT) as an option for many of these patients. Decisions must be individualized, taking into account the pattern of relapse, previous treatment, and functional status, as well as the patient’s preferences and expected quality of life. Many questions remain unanswered with respect to re-RT: Who is the most appropriate candidate, which dose and fractionation are most effective, how to define the target volume, which imaging technique is best for planning, and what is the optimal timing? This review will focus on describing the most relevant studies that include re-RT as salvage therapy, with the aim of simplifying decision-making and designing the best available therapeutic strategy.

Keywords: Re-irradiation; Recurrent glioma; High-grade gliomas; Glioblastoma; Radiosurgery; Stereotactic radiotherapy

Core Tip: The optimal management after recurrence or progression of high-grade gliomas is still undefined. Improved radiation therapy techniques, new imaging methods, published experience, as well as better radiobiological knowledge of the brain tissue have positioned re-irradiation as a valid alternative for many of these patients. Many questions remain unanswered. This review will focus on describing the most relevant studies that include re-irradiation as salvage treatment, with the aim of simplifying decision-making and designing the best available therapeutic strategy.