1518 / 1708
11.9 months and died, 2 experienced progression with com-
bined local and distant recurrence at 8.3 and 18.5 months and
died, 1 died of radiation necrosis at 40 months, and 1 patient
remains without evidence of disease 10 years after SRS, but
required surgery and HBOT 8 years after SRS for necrosis.
Notably, all 4 patients who experienced disease progression
and died had neuroimaging or pathologic evidence of necro-
sis. Despite the poor outcome, the progression-free survival
of second radiation course/progression-free survival of first
radiation course (PFS
RT2
/PFS
RT1
) ratio was greater than
unity for 4 of 6 patients and was 1.89 for the only survivor,
whose initial recurrence was experienced 66 months after
her initial treatment with GTR and 50 Gy.
RT
2
: FFRT
Thirteen patients with local failure were treated by using
FFRT to a median dose of 52.2 Gy (range, 50.4–54 Gy). Me-
dian combined total dose was 111.6 Gy (range, 98.4–120
Gy). Median time from initiation of RT
1
to RT
2
was 23
months (range, 10–82 months), and from RT
1
failure to
RT
2
, 4 months (range, 1–66 months). Twelve of 13 patients
underwent repeated resection at the time of RT
1
failure. The
group was composed of 11 patients with an infratentorial pri-
mary tumor location. Surgery was not performed in 1 of 2 pa-
tients with a supratentorial primary tumor location. Two
patients underwent multiple attempts at resection and chemo-
therapy regimens before RT
2
, which facilitated the two lon-
gest delays from RT
1
failure to RT
2
of 23.4 and 66 months.
Three patients in this group experienced progression with
metastatic failure at 4, 6, and 7 months and subsequently
died at 10, 17, and 20 months after RT
2
despite additional
therapy. Widespread metastatic disease, including metastatic
disease in the region of the primary site, made it difficult to
determine the durability of local control. The remaining 10
Table 2. Patient disease control intervals and outcomes according to reirradiation volume and initial pattern of failure.
Patient
Reirradiation
volume
Initial pattern
of failure
PFS, RT1
(months)
PFS, RT2
(months)
PFSRT1/PF
SRT2
RT2
progression
Disease
status
Overall survival
(months)
1
SRS
Local
10
18.50
1.80
Yes
DOD
65.5
2
SRS
Local
20
6.23
0.31
No
DOD
57.5
3
SRS
Local
27
11.90
0.43
Yes
DOD
65.1
4
SRS
Local
37
40.53
1.11
Yes
DOC
79.0
5
SRS
Local
66
125.27
1.89
No
NED 194.6
6
SRS
Metastatic
6
8.27
3.28
Yes
DOD
24.7
7
Local
Local
9
76.83
8.44
No
NED 190.2
8
Local
Local
9
1.43
0.15
No
SD
13.5
9
Local
Local
10
4.10
0.41
Yes
DOD
48.6
10
Local
Local
13
7.70
0.58
Yes
DOD
26.3
11
Local
Local
14
38.63
2.85
No
NED
60.7
12
Local
Local
15
6.07
0.41
Yes
DOD
46.2
13
Local
Local
16
136.33
8.72
No
NED 169.8
14
Local
Local
16
2.63
0.16
No
NED
35.7
15
Local
Local
19
4.43
0.23
No
NED
33.1
16
Local
Local
21
8.67
0.42
No
NED
34.5
17
Local
Local
23
41.10
1.77
No
NED
69.1
18
Local
Local
59
78.47
1.33
No
NED 169.2
19
Local
Local
73
29.87
0.41
No
NED 109.6
20
CSI
Metastatic
3
22.17
7.15
No
SD
31.5
21
CSI
Combined
7
6.80
1.01
Yes
DOD
24.2
22
CSI
Combined
10
9.63
0.99
Yes
DOD
35.0
23
CSI
Metastatic
11
19.03
1.74
Yes
PD
71.2
24
CSI
Metastatic
17
24.30
1.40
No
NED
51.8
25
CSI
Metastatic
18
18.97
1.07
No
NED
39.7
26
CSI
Combined
19
8.53
0.45
Yes
DOD
37.1
27
CSI
Metastatic
22
69.73
3.24
No
NED 103.2
28
CSI
Metastatic
22
40.70
1.89
No
SD
139.9
29
CSI
Metastatic
22
49.50
2.23
No
NED
75.1
30
CSI
Metastatic
23
4.43
0.19
No
NED
29.8
31
CSI
Metastatic
25
2.53
0.00
No
SD
35.5
32
CSI
Combined
26
261.03
10.21
No
NED 303.9
33
CSI
Metastatic
26
40.67
1.56
Yes
PD
77.6
34
CSI
Local
27
6.03
0.23
Yes
DOD
70.0
35
CSI
Local
28
14.87
0.53
No
SD
49.3
36
CSI
Local
35
13.30
0.38
No
NED
59.3
37
CSI
Metastatic
43
32.40
0.76
Yes
PD
78.4
38
CSI
Metastatic
62
19.30
0.31
No
SD
92.9
Abbreviations:
SRS = stereotactic radiosurgery; CSI = craniospinal irradiation; PFS = progression-free survival; RT1 = initial radiation ther-
apy; RT2 = reirradiation; DOD = dead of disease; DOC = dead of other causes; NED = no evidence of disease; SD = stable disease.
92
I. J. Radiation Oncology
d
Biology
d
Physics
Volume 71, Number 1, 2008