Reirradiation for recurrent glioblastoma: the significance of the residual tumor volume

Mansoorian S, Schmidt M, Weissmann T, Delev D, Heiland DH, Coras R, Stritzelberger J, Saake M, Höfler D, Schubert P, Schmitter C, Lettmaier S, Filimonova I, Frey B, Gaipl U, Distel L, Semrau S, Bert C, Eze C, Schönecker S, Belka C, Blümcke I, Uder M, Schnell O, Dörfler A, Fietkau R, Putz F (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Journal of Neuro-Oncology Springer Verlag (Germany)

DOI: 10.1007/s11060-025-05042-9

Abstract

Purpose: Recurrent glioblastoma has a poor prognosis, and its optimal management remains unclear. Reirradiation (re-RT) is a promising treatment option, but long-term outcomes and optimal patient selection criteria are not well established. Methods: This study analyzed 71 patients with recurrent CNS WHO grade 4, IDHwt glioblastoma (GBM) who underwent re-RT at the University of Erlangen-Nuremberg between January 2009 and June 2019. Imaging follow-ups were conducted every 3 months. Progression-free survival (PFS) was defined using RANO criteria. Outcomes, feasibility, and toxicity of re-RT were evaluated. Contrast-enhancing tumor volume was measured using a deep learning auto-segmentation pipeline with expert validation and jointly evaluated with clinical and molecular-pathologic factors. Results: Most patients were prescribed conventionally fractionated re-RT (84.5%) with 45 Gy in 1.8 Gy fractions, combined with temozolomide (TMZ, 49.3%) or lomustine (CCNU, 12.7%). Re-RT was completed as planned in 94.4% of patients. After a median follow-up of 73.8 months, 88.7% of patients had died. The median overall survival was 9.6 months, and the median progression-free survival was 5.3 months. Multivariate analysis identified residual contrast-enhancing tumor volume at re-RT (HR 1.040 per cm3, p < 0.001) as the single dominant predictor of overall survival. Conclusion: Conventional fractionated re-RT is a feasible and effective treatment for recurrent high-grade glioma. The significant prognostic impact of residual tumor volume highlights the importance of combining maximum-safe resection with re-RT for improved outcomes.

Authors with CRIS profile

Sina Mansoorian Department of Radiation Oncology Thomas Weissmann Department of Radiation Oncology Daniel Höfler Department of Radiation Oncology Philipp Schubert Department of Radiation Oncology Charlotte Schmitter Department of Radiation Oncology Irina Filimonova Lehrstuhl für Strahlentherapie Benjamin Frey Department of Radiation Oncology Udo Gaipl Department of Radiation Oncology Luitpold Distel Department of Radiation Oncology Sabine Semrau Medizinische Fakultät Christoph Bert Professur für Med. Strahlenphysik Rainer Fietkau Lehrstuhl für Strahlentherapie Florian Putz Department of Radiation Oncology

Involved external institutions

LMU Klinikum DE Germany (DE) Klinikum der Universität München DE Germany (DE)

How to cite

APA:

Mansoorian, S., Schmidt, M., Weissmann, T., Delev, D., Heiland, D.H., Coras, R.,... Putz, F. (2025). Reirradiation for recurrent glioblastoma: the significance of the residual tumor volume. Journal of Neuro-Oncology. https://doi.org/10.1007/s11060-025-05042-9

MLA:

Mansoorian, Sina, et al. "Reirradiation for recurrent glioblastoma: the significance of the residual tumor volume." Journal of Neuro-Oncology (2025).

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