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  • Title: [The possibilities of fractionated external beam repeat irradiation of relapsed primary brain tumours: the first Hungarian experience].
    Author: Mangel L, Sipos L, Fedorcsák I, Viola A, Julow J, Bajcsay A, Németh G, Fodor J.
    Journal: Orv Hetil; 2007 Sep 30; 148(39):1843-9. PubMed ID: 17890172.
    Abstract:
    INTRODUCTION: The practice of image-based three dimensional treatment planning and conformal radiotherapy techniques offer the opportunity to elaborate novel treatment forms, e.g. repeat irradiation techniques for primary brain tumours. AIM: The authors analysed the effect on survival and toxicity of fractionated external beam repeat irradiation in brain tumour patients. METHODS: At the National Institute of Oncology, between 2002 and 2006, fractionated external beam repeat irradiation was performed in eleven patients with recurrent primary brain tumour, with total of 50-54 Gy or near total of 34-40 Gy doses. All patients were previously treated with total radiotherapy doses of 50-64 Gy. The intervals between radiotherapy courses were in the range of 7-30 years. All the treatments were carried out with 3D image-based conformal methods, the fractionation was conventional, with 1,8-2,0 Gy daily fractions in all cases. RESULTS: The repeat irradiation was tolerated well in the material. No grade 3-4 acute toxicity was detected, and serious, grade 3 mental deterioration, not related tumour progression was observed in only one case. In one case reoperation was necessary due to histologically verified radio-necrosis with mass-effect, and we believe that late neurotoxicity caused serious functional inabilities in one case. The median progression free survival was 8 (2-33) months, the median survival was 13 (4,5-33) months. Three of our patients were alive at the end of the study. CONCLUSIONS: Based on this experience and current knowledge, in absence of other treatment possibilities, the fractionated external beam repeat irradiation with near total doses could be a therapeutic choice in case of recurrent primary brain tumours, if having appropriate background. To define the optimal treatment strategy and regimens, further clinical trials should be carried out.
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