A Phase I Dose-Escalation Study of Fractionated Stereotactic Radiosurgery in Combination With Gefitinib in Patients With Recurrent Malignant Gliomas

Schwer, Amanda; Damek, Denise; Kavanagh, Brian D.; Gaspar, Laurie E.; Lillehei, Kevin O.; Stuhr, Kelly; Chen, Changhu

doi:10.1016/j.ijrobp.2007.07.2382

Cited by 66 publications

(29 citation statements)

References 25 publications

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“…In this regard, several different modalities of percutaneous radiotherapy or brachytherapy for retreatment of glioblastomas have been investigated. In general, all data consistently show that, whenever employed cautiously, reirradiation is feasible and most likely prolongs survival [1,4,7,8,11,13,14,21,24,34,35,38,[40][41][42].…”

Section: Introductionmentioning

confidence: 76%

Hypofractionated reirradiation for recurrent malignant glioma

Henke

Paulsen²,

Steinbach

et al. 2009

Strahlenther Onkol

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Section: Introductionmentioning

confidence: 76%

Hypofractionated reirradiation for recurrent malignant glioma

Henke

Paulsen²,

Steinbach

et al. 2009

Strahlenther Onkol

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“…17 Trials have shown that multimodality treatment involving radiosurgery, RT, and chemotherapy is feasible and relatively well tolerated. 18,19,35 The RPA Classification System Curran et al performed the original RPA of prognostic factors in three RTOG trials more than 2 decades ago. 6 This analysis included 1578 patients with GBM or anaplastic astrocytoma and generated 6 prognostic classes (Classes I and II for anaplastic astrocytoma, and Classes III-VI for GBM).…”

Section: Other Srs Studies For Patients With Glioblastomamentioning

confidence: 99%

Role of adjuvant or salvage radiosurgery in the management of unresected residual or progressive glioblastoma multiforme in the pre–bevacizumab era

Niranjan

Kano

Iyer

et al. 2015

JNS

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abbreviatioNs ARE = adverse radiation effect; GBM = glioblastoma multiforme; KPS = Karnofsky Performance Scale; MST = median survival time; OS = overall survival; PFS = progression-free survival; RPA = recursive partitioning analysis; RT = radiation therapy; RTOG = Radiation Therapy Oncology Group; SRS = stereotactic radiosurgery. obJect After initial standard of care management of glioblastoma multiforme (GBM), relatively few proven options remain for patients with unresected progressive tumor. Numerous reports describe the value of radiosurgery, yet this modality appears to remain underutilized. The authors analyzed the outcomes of early adjuvant stereotactic radiosurgery (SRS) for unresected tumor or later salvage SRS for progressive GBM. Radiosurgery was performed as part of the multimodality management and was combined with other therapies. Patients continued to receive additional chemotherapy after SRS and prior to progression being documented. In this retrospective analysis, the authors evaluated factors that affected patient overall survival (OS) and progression-free survival. methods Between 1987 and 2008 the authors performed Gamma Knife SRS in 297 patients with histologically proven GBMs. All patients had received prior fractionated radiation therapy, and 66% had undergone one or more chemotherapy regimens. Ninety-six patients with deep-seated unresectable GBMs underwent biopsy only. Of those in whom excision had been possible, resection was considered to be gross total in 68 and subtotal in 133. The median patient age was 58 years (range 23-89 years) and the median tumor volume was 14 cm 3 (range 0.26-84.2 cm 3 ). The median prescription dose delivered to the imaging-defined tumor margin was 15 Gy (range 9-25 Gy). The median follow-up duration was 8.6 months (range 1.1-173 months). Cox regression models were used to analyze survival outcomes. Variables examined included age, residual versus recurrent tumor, prior chemotherapy, time to first recurrence, SRS dose, and gross tumor volume. results The median survival times after radiosurgery and after diagnosis were 9.03 and 18.1 months, respectively. The 1-year and 2-year OS after SRS were 37.9% and 16.7%, respectively. The 1-year and 2-year OS after diagnosis were 76.2% and 30.8%, respectively. Using multivariate analysis, factors associated with improved OS after diagnosis were younger age (< 60 years) at diagnosis (p < 0.0001), tumor volume < 14 cm 3 (p < 0.001), use of prior chemotherapy (p = 0.001), and radiosurgery at the time of recurrence (p < 0.0001). Multivariate analysis showed that younger age (p < 0.0001) and smaller tumor volume (< 14 cm 3 ) (p = 0.001) were significantly associated with increased OS after SRS. Adverse radiation effects were seen in 69 patients (23%). Fifty-eight patients (19.5%) underwent additional resection after SRS. The median survivals after diagnosis for recursive partitioning analysis Classes III, IV and V+VI were 31.6, 20.8, and 16.7 months, respectively. coNclusioNs In this analysis 30% of a heterogeneous cohort ...

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“…41 Other trials have shown that the multimodality treatment of stereotactic radiosurgery, radiotherapy, and chemotherapy is feasible and well tolerated, with survival times similar to those for other treatment modalities. 43,44,61,86 …”

Section: Stereotactic Radiosurgery and Fsrt For The Treatment Of Recumentioning

confidence: 99%

“…A number of early retrospective studies on the use of SRS and fSRT for recurrent GBM have shown promise. 15,21,23,30,33,34,36,40,43,44,47,53,61,67,81,86 In this paper, we discuss the role of SRS and fSRT in the multimodal treatment of this disease, with particular emphasis on the treatment of focal relapse.…”

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confidence: 99%

Role of stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of recurrent glioblastoma multiforme

Romanelli

Conti²,

Pontoriero

et al. 2009

FOC

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Glioblastoma multiforme (GBM) is a devastating malignant brain tumor characterized by resistance to available therapeutic approaches and relentless malignant progression that includes widespread intracranial invasion, destruction of normal brain tissue, progressive disability, and death. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) are increasingly used in patients with recurrent GBM to complement traditional treatments such as resection, conventional external beam radiotherapy, and chemotherapy. Both SRS and fSRT are powerful noninvasive therapeutic modalities well suited to treat focal neoplastic lesions through the delivery of precise, highdose radiation. Although no randomized clinical trials have been performed, a variety of retrospective studies have been focused on the use of SRS and fSRT for recurrent GBMs. In addition, state-of-the-art neuroimaging techniques, such as MR spectroscopic imaging, diffusion tensor tractography, and nuclear medicine imaging, have enhanced treatment planning methods leading to potentially improved clinical outcomes. In this paper the authors reviewed the current applications and efficacy of SRS and fSRT in the treatment of GBM, highlighting the value of these therapies for recurrent focal disease.

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A Phase I Dose-Escalation Study of Fractionated Stereotactic Radiosurgery in Combination With Gefitinib in Patients With Recurrent Malignant Gliomas

Cited by 66 publications

References 25 publications

Hypofractionated reirradiation for recurrent malignant glioma

Hypofractionated reirradiation for recurrent malignant glioma

Role of adjuvant or salvage radiosurgery in the management of unresected residual or progressive glioblastoma multiforme in the pre–bevacizumab era

Role of stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of recurrent glioblastoma multiforme

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