Single dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas

Cho, Kwan H.; Hall, Walter A.; Gerbi, Bruce J.; Higgins, Patrick D.; McGuire, Warren A.; Clark, H. Brent

doi:10.1016/s0360-3016(99)00336-3

Cited by 173 publications

(118 citation statements)

References 23 publications

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“…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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mentioning

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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“…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]. A higher incidence of toxicities is seen in the setting of HFSRT with concomitant chemotherapy.…”

Section: Discussionmentioning

confidence: 96%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Jia

Pannullo

Schwartz

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…Median survival after srs is in the range of 8-16 months [44][45][46][47][48] . Potential adverse effects include radiation necrosis, edema, hydrocephalus, and worsening of previous symptoms.…”

Section: Re-irradiationmentioning

confidence: 99%

Canadian Recommendations for the Treatment of Recurrent or Progressive Glioblastoma Multiforme

Easaw¹,

Mason²,

Perry³

et al. 2011

Current Oncology

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Recommendation 1: Multidisciplinary Approach: To optimize treatment outcomes, the management of patients with recurrent glioblastoma should be individualized and should involve a multidisciplinary team approach, including neurosurgery, neuropathology, radiation oncology, neuro-oncology, and allied health professions. Recommendation 2: Imaging: The standard imaging modality for assessment of recurrent glioblastoma is Gd-enhanced magnetic resonance imaging (MRI). Tumour recurrence should be assessed according to the criteria set out by the Response Assessment in Neuro-Oncology Working Group. The optimal timing and frequency of MRI after chemoradiation and adjunctive therapy have not been established. Recommendation 3: Pseudo-progression: Progression observed by MRI after chemoradiation can be pseudo-progression. Accordingly, treated patients should not be classified as having progressive disease by Gd-enhancing MRI within the first 12 weeks after the end of radiotherapy unless new enhancement is observed outside the radiotherapy field or viable tumour is confirmed by pathology at the time of a required re-operation. Adjuvant temozolomide should be continued and follow-up imaging obtained. Recommendation 4: Repeat Surgery: Surgery can play a role in providing symptom relief and confirming tumour recurrence, pseudo-progression, or radiation necrosis. However, before surgical intervention, it is essential to clearly define treatment goals and the expected impact on prognosis and the patient’s quality of life. In the absence of level 1 evidence, the decision to re-operate should be made according to individual circumstances, in consultation with the multidisciplinary team and the patient. Recommendation 5: Re-irradiation: Re-irradiation is seldom recommended, but can be considered in carefully selected cases of recurrent glioblastoma. Recommendation 6: Systemic Therapy: Clinical trials, when available, should be offered to all eligible patients. In the absence of a trial, systemic therapy, including temozolomide rechallenge or antiangiogenic therapy, may be considered. Combination therapy is still experimental; optimal drug combinations and sequencing have not been established.

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Single dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas

Cited by 173 publications

References 23 publications

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

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

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

Canadian Recommendations for the Treatment of Recurrent or Progressive Glioblastoma Multiforme

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