Hypofractionated stereotactic radiation therapy for recurrent glioblastoma: single institutional experience

Abstract

BackgroundGlioblastoma (GBM) is the most common malignant primary brain tumor in adults. Tumor control and survival have improved with the use of radiotherapy (RT) plus concomitant and adjuvant chemotherapy, but the prognosis remain poor. In most cases the recurrence occurs within 7–9 months after primary treatment. Currently, many approaches are available for the salvage treatment of patients with recurrent GBM, including resection, re-irradiation or systemic agents, but no standard of care exists.MethodsWe analysed a cohort of patients with recurrent GBM treated with frame-less hypofractionated stereotactic radiation therapy with a total dose of 25 Gy in 5 fractions.ResultsOf 91 consecutive patients with newly diagnosed GBM treated between 2007 and 2012 with conventional adjuvant chemo-radiation therapy, 15 underwent salvage RT at recurrence. The median time interval between primary RT and salvage RT was 10.8 months (range, 6–54 months). Overall, patients undergoing salvage RT showed a longer survival, with a median survival of 33 vs. 9.9 months (p= 0.00149). Median overall survival (OS) from salvage RT was 9.5 months. No patients demonstrated clinically significant acute morbidity, and all patients were able to complete the prescribed radiation therapy without interruption.ConclusionOur results suggest that hypofractionated stereotactic radiation therapy is effective and safe in recurrent GBM. However, until prospective randomized trials will confirm these results, the decision for salvage treatment should remain individual and based on a multidisciplinary evaluation of each patient.

Concurrent hyperthermia and re-irradiation for recurrent high-grade gliomas

“…It was ultimately decided that patients with poor prognosis with limited salvage treatment options would be selected. The median KPS of patients receiving re-RT with HT was 60, lower than that in previous studies [25,27]. Furthermore, we did not compare the combination of RT and HT with RT alone.…”

“…In another study, patients receiving RT with 30 Gy in 5 fractions had a median OS of 7.9 months after re-RT [24]. Ciamella et al found that the median OS was 9.5 months in a HFSRT study with 25 Gy administered in 5 fractions [25].…”

“…Furthermore, the median OS was longer than that of patients receiving supportive care (8.4 vs. 2.5 months) [25]. However, in the previous study, the majority of patients had a KPS of over 60 [12,23,25,27], with 92% patients having a KPS of more than 70 [26]. By comparison, in our study, the median KPS was 60 (range, 30-90) and 8 patients (40%) had a KPS of more than 60.…”

Innovative Hypofractionated Stereotactic Regimen Achieves Excellent Local Control With No Radiation Necrosis: Promising Results in the Management of Patients With Small Recurrent Inoperable GBM

“…The highest incidence (36%) was reported by the Royal Marsden experience, where 36 patients with recurrent GBM (median tumor volume 24 cm 3 ) were treated with doses ranging from 20 -50 Gy in 5-Gy per fraction [17]. Following a fractionation scheme of 25 Gy/5 fractions, Ciammella, et al [11] reported neurological deterioration reversible with dexamethasone in 13% of patients. Another study using a median dose of 37.5 Gy/15 fractions in 25 patients reported clinical necrosis in one patient and cranial nerve palsy in another patient [10].…”

“…Of these, HFSRT has emerged as a noninvasive method to deliver a high dose of radiation to the tumor site. In the treatment of recurrent GBM, numerous studies have documented a survival advantage on the use of HFSRT [10][11][12][13][14][15][16][17][18] and HFSRT in combination with chemotherapy [19][20][21][22][23][24]. Specifically, Iuchi, et al [25] has shown that a single dose of more than 20 Gy is able to achieve durable local control in 72% of patients; however, radiation necrosis (RN) was observed in 43% of patients.…”