Hypofractionated stereotactic radiotherapy for unifocal and multifocal recurrence of malignant gliomas

Abstract

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.

Genetic, epigenetic, and molecular landscapes of multifocal and multicentric glioblastoma

“…In the literature, the reported incidence of multiple lesions at the time of diagnosis ranges from 0.5% to 35%, depending on the criteria [11, 15, 27]. More recent studies using a definition similar to ours documented M-GBM rates of 10%–15% [18].…”

Multicenter, Phase 1, Dose Escalation Study of Hypofractionated Stereotactic Radiation Therapy With Bevacizumab for Recurrent Glioblastoma and Anaplastic Astrocytoma

“…Moreover, the convenience of a condensed treatment schedule is an important consideration, especially in patients with recurrent glioma who often have poor performance status, limited mobility, and a short expected life span. Overall, data from studies employing re-irradiation at disease recurrence, alone 17–30 or in combination with temozolomide 31–37 , nitrosourea 38 , sorafenib 39 , sunitinib, 40 gefitinib, 41 panobinostat 42 or bevacizumab 12,13,38,43 support a therapeutic benefit with minimal toxicity. In particular, most of these studies have consistently reported a median OS in excess of 10 months, which compares favorably to available salvage chemotherapy or biologic therapies that typically achieve median OS of 7–9 months.…”

Recurrent Malignant Gliomas

“…For example, in the retrospective study from Duke University, 82 4 of 21 (19%) patients treated with SRS alone exhibited symptomatic radionecrosis vs only 2 of 42 (5%) patients receiving both SRS and BVZ. Similarly, in the studies from Memorial Sloan-Kettering Cancer Center, 83 Ludwig Maximilian University of Munich, 89 and the University of Cincinnati, 90 0%, 7%, and 9% rates of radionecrosis were observed in patients receiving SRS and BVZ, respectively.…”