what are the RT options for multifocal recurrence of GBM?

[Kroll2013]

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dear friends,
What are my radiation therapy options for a 60 yo pt, gd KPS
treated one year ago for a left temporal GBM, completely resected, followed by CRT (TMZ + 60 Gy IMRT) and 6 mo of adjuvant TMZ.
one month ago, he developed multifocal recurrences in left hemisphere: 4cm nodular lesion in the temporal TB, 3cm left frontal lesion, 3cm left parietal lesion.
he is already on CCNU+ avastin
clinically: very mild symptoms.
he was referred to our dpt to discuss the possibility of re-RT.
- no RT, continue with only salvage CT ?
- conformal re-RT of the left hemisphere with field in field in order not to exceed 100 Gy cumulative total dose?
- FSRT on the three lesions ?

THANK YOU

 

[Gfunk6]

Multi focal recurrence = very poor prognosis. I would not perform salvage XRT. I'm pretty sure this scenario would be ineligible for re-XRT per RTOG 1205 criteria (though being on Avastin is already disqualifying).

Would consider salvage CHemo vs Optune.

 

[Palex80]

I wouldn't do it either.

From the data I've seen so far, Optune seems to work good as maintenance therapy. It's role as a sole treatment in recurrent patients is not that clear, since data is limited on that. Would you agree Gfunk?

 

[Gfunk6]

Optune was originally FDA approved for recurrent GBM based on randomized Phase III trial by Stupp.

Link: http://www.ncbi.nlm.nih.gov/m/pubmed/22608262/?i=18&from=novottf

No OS benefit but less toxicity and better QoL than Chemo.

 

[Kroll2013]

Multi focal recurrence = very poor prognosis. I would not perform salvage XRT. I'm pretty sure this scenario would be ineligible for re-XRT per RTOG 1205 criteria (though being on Avastin is already disqualifying).

Would consider salvage CHemo vs Optune.

thank you.