To evaluate the efficacy and safety of stereotactic radiotherapy (SRT) for unifocal and multifocal recurrence of malignant gliomas. Between June 2007 and October 2010, 35 consecutive patients with 47 recurrent lesions were treated with salvage SRT at the University of Cincinnati. Thirty-three patients treated had a diagnosis of high grade glioma, four Grade III and twenty-nine Grade IV, while two patients initially were diagnosed with grade II tumors but recurred as high grade lesions. All patients had previously received a median dose of 59.4 Gy. Twenty-six patients were treated for a single lesion, and nine patients were treated for multiple lesions. Using SRT, patients were re-treated with a median total dose of 30 Gy in a median of five fractions. Median survival from diagnosis was 22 months and median survival following SRT was 8.6 months. The median survival following SRT for those patients treated for multifocal recurrence was 7.9 versus 10 months for those treated for unifocal recurrence (p = 0.7). Multivariate analysis showed local control of the SRT treated lesion(s) 6 months after SRT was associated with a significant improvement in survival (p ≤ 0.01). All patients tolerated their treatment well and completed their prescribed SRT as planned. Three patients (9 %) were felt to possibly have developed radiation necrosis following therapy. SRT was both well tolerated and efficacious with the local control provided by SRT resulting in improved overall survival. This benefit also seems to be apparent for patients with multi-focal recurrence.

Superior vena cava syndrome (SVCS) is characterized by a spectrum of clinical findings that result from the occlusion of the superior vena cava (SVC), usually caused by extracaval compression of the SVC by either a bronchogenic tumor or an enlarged mediastinal lymph node. Most efforts at treatment for SVCS are palliative, and long-term survival for malignancy-related SVCS is very low. Therefore, radiotherapy treatment is usually delivered with palliative intent utilizing hypofractionated regimens. The use of high dose per fraction may result in more rapid and more durable responses to treatment. Similarly, the high dose per fraction utilized in stereotactic body radiotherapy (SBRT) has been proven highly efficacious in treating early stage non-small cell lung cancer (NSCLC). Here we report the first reported case of a patient with SVCS from NSCLC successfully treated with SBRT to alleviate SVCS.

Conclusion: Among patients previously treated with definitive EBRT, salvage LDR brachytherapy for localized intra-prostatic recurrence was safe with an acceptable rate of grade 3+ toxicity. Additionally, salvage LDR brachytherapy proved efficacious with 62% of patients remaining disease free at 5 years. Additional patients and longer follow-up are needed to confirm these results.

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