What dose would you consider for a patient who received 59.4 Gy 18 years ago for a glioma of the right frontal lobe who is now S/P gross total resection for a high-grade glioma in the same area?

Particularly, would you have concerns about OAR constraints or cumulative dose? Patient has excellent performance status and no neuro deficits post operative.

Answer from: Radiation Oncologist at Community Practice

Given that the patient was treated 18 years ago and has undergone GTR, I would be more inclined to treat to the full dose using standard fractionation; 54-59.4 Gy in 30-33 fractions (depending on molecular features). I would treat with concurrent bevacizumab in addition to any other systemic therapy...

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Radiation Oncologist at OSF Saint Anthony Medical Center
Thank you for your response.

Answer from: Radiation Oncologist at Academic Institution

Based on the monkey spinal cord re-irradiation experiment done at M.D. Anderson many years ago, we learned that spinal cord repair after radiation was almost complete after 3 years. If we extrapolate the data to brain tissues and structures, we could now deliver the usual 59.4 or 60 Gy to the same a...

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Radiation Oncologist at OSF Saint Anthony Medical Center
Thank you for your response.

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What dose would you consider for a patient who received 59.4 Gy 18 years ago for a glioma of the right frontal lobe who is now S/P gross total resection for a high-grade glioma in the same area?

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