Re-resection for recurrent high-grade XXXX in the setting of re-irradiation: more is not always better.

@entity1 @entity11 @entity5
UNASSIGNED: The optimal treatment for @entity1 with recurrent high grade @entity11 (HGG) remains controversial. Available therapies include surgery, re-irradiation, alternating electric fields or systemic therapy. Here we investigate whether re-resection will improve survival in @entity1 receiving repeat radiotherapy for @entity5 recurrence. 231 consecutive @entity1 with recurrent HGG treated with re-irradiation between 1994 and 2012 were analyzed. 105 @entity1 underwent re-resection. Re-irradiation was delivered using daily fractions of 3.5  Gy to a median total dose of 35  Gy. Survival was then analyzed comparing @entity1 with and without re-resection. Overall survival (OS) and survival from the first recurrence are reported. Univariate and cox-proportional hazard modeling was performed in a step-wise multivariate analysis using known prognostic factors. The median follow-up time from initial diagnosis was 25.7  months. The median OS from initial diagnosis of the entire group was 22.5  months. There was no significant difference in median overall survival between @entity1 who received re-resection versus no re-resection, 23 versus 21.9  months respectively (p  =  0.6). Additionally, there was no difference in median survival from the time of first recurrence 10.5  months without re-resection versus 11.1  months with re-resection (p  =  0.09). After adjusting for known prognostic variables, only age remained significant. Re-irradiation is an effective salvage therapy for @entity1 with localized, progressive high grade @entity11 , achieving a median survival of 10-11  months from re-irradiation. Our data reveals no significant improvement in survival with the addition of re-resection to re-irradiated @entity1 with HGG.
