Study Protocol: Early Stereotactic Gamma Knife Radiosurgery to Residual Tumor After Surgery of Newly Diagnosed Glioblastoma (Gamma-GBM)

Brehmer, Stefanie; Grimm, Maximilian; Förster, Alex; Seiz-Rosenhagen, Marcel; Welzel, Grit; Stieler, Florian; Wenz, Frederik; Groden, Christoph; Mai, Sabine; Hänggi, Daniel; Giordano, Frank A.

doi:10.1093/neuros/nyy156

Cited by 4 publications

(3 citation statements)

References 25 publications

(23 reference statements)

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“…Phase II trials are currently underway, evaluating the efficacy of PBT as a frontline treatment compared to standard dose radiotherapy with TMZ. The delivery of high dose radiation to the tumor can also be achieved via Gamma Knife Radiosurgery, which has been utilized for the treatment of recurrent GBM [ 54 , 55 , 56 ]. It has been observed that significant radiation-induced edema occurs in patients who receive high radiation doses; however, these adverse side effects were reduced, and patient survival prolonged when combined with bevacizumab [ 57 , 58 ].…”

Section: Therapeutic Strategies For Glioblastomamentioning

confidence: 99%

Novel Treatment Strategies for Glioblastoma

Stylli

2020

Cancers

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Glioblastoma (GBM) is the most common primary central nervous system tumor in adults. It is a highly invasive disease, making it difficult to achieve a complete surgical resection, resulting in poor prognosis with a median survival of 12–15 months after diagnosis, and less than 5% of patients survive more than 5 years. Surgical, instrument technology, diagnostic and radio/chemotherapeutic strategies have slowly evolved over time, but this has not translated into significant increases in patient survival. The current standard of care for GBM patients involving surgery, radiotherapy, and concomitant chemotherapy temozolomide (known as the Stupp protocol), has only provided a modest increase of 2.5 months in median survival, since the landmark publication in 2005. There has been considerable effort in recent years to increase our knowledge of the molecular landscape of GBM through advances in technology such as next-generation sequencing, which has led to the stratification of the disease into several genetic subtypes. Current treatments are far from satisfactory, and studies investigating acquired/inherent resistance to current therapies, restricted drug delivery, inter/intra-tumoral heterogeneity, drug repurposing and a tumor immune-evasive environment have been the focus of intense research over recent years. While the clinical advancement of GBM therapeutics has seen limited progression compared to other cancers, developments in novel treatment strategies that are being investigated are displaying encouraging signs for combating this disease. This aim of this editorial is to provide a brief overview of a select number of these novel therapeutic approaches.

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Section: Therapeutic Strategies For Glioblastomamentioning

confidence: 99%

Novel Treatment Strategies for Glioblastoma

Stylli

2020

Cancers

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“…Unlike advancing age, the EOR plays an important role in improving survival. The purpose of the surgical resection is to remove the tumor as much as possible, alleviating the mass effect, to obtain brain tissue for the analysis of the pathology [42]. However, in 90% of cases, the tumor recurrence can occur within a 2-cm margin of the primary site [43].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Extent of Resection on the Prognosis of Glioblastoma Multiforme: A Systematic Review and Meta-analysis

Chaulagain

Smolanka

et al. 2022

Open Access Maced J Med Sci

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Purpose: To investigate the predictor factors of mortality describing the prognosis of primary surgical resection of Glioblastoma Multiforme (GBM). Materials and Methods: A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 12th September 2021. All statistical analysis was conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result were reported in the Hazards Ratio (HR) and corresponding 95% Confidence interval (CI). Result: Twenty-three cohort studies were selected for meta-analysis. There was statistically significant effect of extent of resection on prognosis of surgery in GBM patients (HR= 0.90 [0.86, 0.95]; p< 0.0001; I2= 96%), male gender (HR= 1.19 [1.06, 1.34]; p= 0.002; I2= 0%) and decrease Karnofsky Performance Status (HR= 0.97 [0.95, 0.99]; p= 0.003; I2= 90%). Age and tumor volume was also analyzed in the study. Conclusion: The results of our meta-analysis suggested that age, gender, pre-operative KPS score and extent of resection have significant effects on the post-surgical mortality rate, therefore, these factors can be used significant predictor of mortality in GBM patients.

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“…Thus, early postoperative EBRT in the form of SRS has not demonstrated conclusive efficacy. A future trial will test SRS ≤ 48 h postoperatively for residual tumour [ 80 ].…”

Section: Clinical Interventionsmentioning

confidence: 99%

Early Therapeutic Interventions for Newly Diagnosed Glioblastoma: Rationale and Review of the Literature

et al. 2022

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Purpose of Review Glioblastoma is the commonest primary brain cancer in adults whose outcomes are amongst the worst of any cancer. The current treatment pathway comprises surgery and postoperative chemoradiotherapy though unresectable diffusely infiltrative tumour cells remain untreated for several weeks post-diagnosis. Intratumoural heterogeneity combined with increased hypoxia in the postoperative tumour microenvironment potentially decreases the efficacy of adjuvant interventions and fails to prevent early postoperative regrowth, called rapid early progression (REP). In this review, we discuss the clinical implications and biological foundations of post-surgery REP. Subsequently, clinical interventions potentially targeting this phenomenon are reviewed systematically. Recent Findings Early interventions include early systemic chemotherapy, neoadjuvant immunotherapy, local therapies delivered during surgery (including Gliadel wafers, nanoparticles and stem cell therapy) and several radiotherapy techniques. We critically appraise and compare these strategies in terms of their efficacy, toxicity, challenges and potential to prolong survival. Finally, we discuss the most promising strategies that could benefit future glioblastoma patients. Summary There is biological rationale to suggest that early interventions could improve the outcome of glioblastoma patients and they should be investigated in future trials.

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Study Protocol: Early Stereotactic Gamma Knife Radiosurgery to Residual Tumor After Surgery of Newly Diagnosed Glioblastoma (Gamma-GBM)

Abstract: Early postoperative SRS to areas of residual tumor could bridge the therapeutic gap between surgery and adjuvant therapies.

Cited by 4 publications

References 25 publications

Novel Treatment Strategies for Glioblastoma

Novel Treatment Strategies for Glioblastoma

The Impact of Extent of Resection on the Prognosis of Glioblastoma Multiforme: A Systematic Review and Meta-analysis

Early Therapeutic Interventions for Newly Diagnosed Glioblastoma: Rationale and Review of the Literature

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