MODERN APPROACHES TO THE TREATMENT OF PATIENTS WITH PROGRESSION OF PRIMARY GLIAL BRAIN TUMORS

The aim of this study was to determine the most effective approach to the treatment of patients with continued growth of brain glioma. Material and methods. The study included 200 patients with progression of primary brain glioma, who, since 2001. to 2021 treatment was carried out on the basis of the Chelyabinsk Regional Center for Oncology and Nuclear Medicine. The mean age was 47.86±11.47 years. The ratio of men and women is 1:1. Reoperation was performed in 46 patients. In 125 cases, continued growth of high-grade glioma was diagnosed, and in 40 patients progression of low-grade glioma was noted. And a group of patients with the transformation of low-grade glioma into high-grade glioma was separately identified. Repeated radiation therapy was performed in 140 patients of them: 17 patients received a course of neuronal therapy in mono mode and in 23 patients in combination with external beam radiation therapy; 45 patients underwent stereotactic radiotherapy (STRT) using the CyberKnife machine; in 55 cases - remote radiation therapy. In 60 patients, the choice of treatment was chemotherapy with Temozolomide (n=45) and Bevacizumab + Irinotecan (n=15). Results and conclusions. Thus, the median overall survival (OS) of patients with progression of high-grade glioma was 36 months, the 1-year OS was 96.0%; 2-year-old - 59.4%. Specific overall survival method - 15 months. OS rates in the group of patients with progression of low-grade brain glioma, as expected, were significantly higher and amounted to 130 months, 1-year OS rates were 97.4%; 5- year-old - 80.3%. Specific overall survival method - 60 months. But the indicators of the specific OS method in patients with transformation were significantly lower -15 months, with OS indicators of 98 months. We noted a trend towards an increase in OS in re-operated patients in all subgroups. Depending on the type of radiation therapy: the highest indicators of the method of specific RH were found during the implementation of STLT and combined photon-neutron therapy for 23 months. and 47 months. (p>0.05). in the subgroup of high-grade glioma and 60 months. and 72 months. in patients with continued growth of low-grade brain glioma (p>0.05). In patients with transformation of low-grade glioma into high-grade ones, the specific OS was higher during chemoradiotherapy compared with patients who received only chemotherapy for 32 months. and 12 months. respectively (p>0.05). Thus, the most optimal approach for the treatment of patients with continued growth of primary glial brain tumors is reoperation. The method of choice for a repeated course of radiation therapy can be stereotactic radiation therapy or a combined course of photon-neutron therapy. Treatment of patients with transformation of low-grade glioma to high-grade glioma should be carried out as for primary malignant glioma and include a repeat course of chemoradiotherapy.

1. Louis D., Perry A., Wesseling P., Brat D., Cree I. The 2021 WHO classification of tumors of the central nervous system: a summary //Neuro-oncology. – 2021. – Т. 23. – №. 8. – С. 1231-1251.

2. Maurizio S., Placido B., Michela R., Mariagrazia N. Retrospective and randomized analysis of influence and correlation of clinical and molecular prognostic factors in a mono-operative series of 122 patients with glioblastoma treated with STR or GTR //Brain sciences. – 2020. – Т. 10. – №. 2. – С. 91.

3. Tom M., Park D., Yang K. Tom M. C. et al. Malignant transformation of molecularly classified adult low-grade glioma //International Journal of Radiation Oncology* Biology* Physics. – 2019. – Т. 105. – №. 5. – С. 1106-1112.

4. Wen P., Weller M., Lee E. Glioblastoma in adults: a Society for Neuro-Oncology (SNO) and European Society of Neuro-Oncology (EANO) consensus review on current management and future directions //Neuro-oncology. – 2020. – Т. 22. – №. 8. – С. 1073-1113.

5. ZhaoY., Wang Z., Pan Z., Péus D. A meta-analysis of survival outcomes following reoperation in recurrent glioblastoma: time to consider the timing of reoperation //Frontiers in neurology. – 2019. – Т. 10. – С. 286.

6. Brian V., Navid R., Daniel J. et al. Management of patients with recurrence of diffuse low grade glioma //Journal of neuro-oncology. – 2015. – Т. 125. – №. 3. – С. 609-630.

7. Wick W., Gorlia T., Bendszus M. Lomustine and bevacizumab in progressive glioblastoma //New England Journal of Medicine. – 2017. – Т. 377. – №. 20. – С. 1954-1963.

8. Wei W., Chen X., Ma X. et al. The efficacy and safety of various dose-dense regimens of temozolomide for recurrent high-grade glioma: a systematic review with meta-analysis //Journal of neuro-oncology. – 2015. – Т. 125. – №. 2. – С. 339-349.

9. Buglione M., Pedretti S., Poliani P. et al. Pattern of relapse of glioblastoma multiforme treated with radical radio-chemotherapy: could a margin reduction be proposed? //Journal of neurooncology. – 2016. – Т. 128. – №. 2. – С. 303-312.

10. Morris S., Zhu P., Rao M. Gamma knife stereotactic radiosurgery in combination with bevacizumab for recurrent glioblastoma //World neurosurgery. – 2019. – Т. 127. – С. e523-e533.

11. Saeed A., Khairnar R., Sharma A. et al. Clinical outcomes in patients with recurrent glioblastoma treated with proton beam therapy reirradiation: analysis of the Multi-Institutional Proton Collaborative Group Registry //Advances in Radiation Oncology. – 2020. – Т. 5. – №. 5. – С. 978-983.

12. Мусабаева Л.И., Чойнзонов Е.Л., Грибова О.В. и др. Нейтронная терапия в лечении радиорезистентных злокачественных новообразований //Сибирский онкологический журнал. – 2016. – Т. 15. – №. 3. – С. 67-71.

13. Терапия быстрыми нейтронами в онкологии //Сибирский онкологический журнал. – 2015. – №. 2. – С. 88-94.

14. Кандакова Е.Ю., Важенин А.В., Кузнецова А.И. и др. Результаты сочетанной фотонно-нейтронной терапии в условиях эскалации дозы нейтронов в общем курсе сочетанной фотонно нейтронной терапии //Вестник Российского научного центра рентгенорадиологии Минздрава России. – 2014. – №. 4. – С. 7.