Stereotactic radiosurgery for recurrent gliomas

Chamberlain, Marc C.; Barba, David; Kormanik, Pattie; Shea, William M.

doi:10.1002/1097-0142(19940815)74:4<1342::aid-cncr2820740426>3.0.co;2-y

Cited by 88 publications

(16 citation statements)

References 25 publications

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“…3,4 Both single-fraction stereotactic radiosurgery (SRS) and brachytherapy have been reported to have modest utility as palliative salvage interventions; however, both have been associated with high rates of re-operation because of associated toxicity. [5][6][7][8][9][10][11][12] Fractionated stereotactic radiotherapy (SRT) may offer some improvement in overall survival with minimal toxicity for patients with previously treated malignant gliomas. SRT allows precise treatment delivery while decreasing the dose to surrounding critical structures, 13 thus obviating the toxicity commonly seen with SRS.…”

Section: Introductionmentioning

confidence: 97%

Hypofractionated Stereotactic Radiation Therapy: An Effective Therapy for Recurrent High-Grade Gliomas

Fogh

Andrews

Glass

et al. 2010

JCO

305

240

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Purpose Salvage options for recurrent high-grade gliomas (HGGs) are limited by cumulative toxicity and limited efficacy despite advances in chemotherapeutic and radiotherapeutic techniques. Previous studies have reported encouraging survival results and favorable toxicity with fractionated stereotactic radiotherapy, and small studies have shown similar benefit using a shortened course of hypofractionated stereotactic radiation therapy (H-SRT). We sought to determine the efficacy and toxicity profile of H-SRT alone or in addition to repeat craniotomy or concomitant chemotherapy. Patients and Methods Between 1994 and 2008, 147 patients with recurrent HGG were treated with H-SRT (median dose, 35 Gy in 3.5-Gy fractions). Cox regression models were used to analyze survival outcomes. Variables included age, surgery before H-SRT, time to first recurrence, reirradiation dose, inclusion of chemotherapy with H-SRT, and gross tumor volume (GTV). Results Younger age (P = .001), smaller GTV (P = .025), and shorter time between diagnosis and recurrence (P = .034) were associated with improvement in survival from H-SRT. Doses of radiation ≥ 35 Gy approached significance (P = .07). There was no significant benefit of surgical resection or chemotherapy in this population when analysis was controlled for other prognostic factors. Conclusion H-SRT was well tolerated and resulted in a median survival time of 11 months after H-SRT, independent of re-operation or concomitant chemotherapy. Patients who experienced recurrence within 6 months after initial treatment had an excellent response and should not be disqualified from H-SRT. This is the largest series to examine the efficacy and tolerability of H-SRT in recurrent HGG.

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Section: Introductionmentioning

confidence: 97%

Hypofractionated Stereotactic Radiation Therapy: An Effective Therapy for Recurrent High-Grade Gliomas

Fogh

Andrews

Glass

et al. 2010

JCO

305

240

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“…A randomized controlled study proved that there was no benefit in upfront SRS before conventional fractionated radiation therapy for patients with glioblastoma. 14 Several reports indicate the usefulness of adjuvant SRS at recurrence for glioblastoma, median survival time after SRS being 4.6 to 16 months, [15][16][17][18][19][20] although a randomized study is needed to prove efficacy. The major cause of treatment failure in managing recurrent glioblastoma by SRS is assumed to be that the highly conformal irradiation spares the surrounding tissue, which is presumably infiltrated with viable tumor cells.…”

Section: Introductionmentioning

confidence: 99%

Extended field stereotactic radiosurgery for recurrent glioblastoma

Koga

Maruyama

Tanaka

et al. 2011

Cancer

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BACKGROUND: Stereotactic radiosurgery (SRS) is among the few therapeutic options for glioblastoma that recurs after standard radiation and chemotherapy, but its efficacy has been limited. METHODS: Since November 2007, the authors have modified the clinical target volume by adding a 0.5-to 1-cm margin to the gadolinium-enhanced area (extended field SRS), in contrast to conventional SRS using no margin to set the clinical target volume. A total of 35 recurred glioblastoma lesions in 9 patients were treated with conventional SRS between December 1990 and January 2007, and 14 lesions in 9 patients were treated with extended field SRS. RESULTS: The median follow-up periods were 7 months (range, 3-29 months) and 8 months (range, 6-27 months), respectively. The local control rate was 47% for conventional SRS and 93% for extended field SRS (P ¼ .0035), and the numbers of radiation necrosis observed in SRS-treated lesions were 2 and 4, respectively. The median overall survival from the diagnosis was 24 months (range, 14-57 months) for conventional SRS and 21 months (range, 15-51 months) for extended field SRS (statistically not significant). Seven patients treated with conventional SRS died during follow-up, 6 from progression of the SRS-treated tumor, whereas 7 patients treated with extended field SRS died during follow-up, 6 from remote intracerebral dissemination. CONCLUSIONS: Extended field SRS was superior to conventional SRS in the local control of small recurrent lesions of glioblastoma, although a further device to suppress remote dissemination may be necessary to increase survival. KEYWORDS: glioblastoma, glioma, gamma knife, stereotactic radiosurgery, radiation therapy, recurrence. INTRODUCTIONGlioblastoma is a highly malignant and aggressive tumor of the central nervous system that corresponds to grade IV of the World Health Organization histological classification. 1 The current standard treatment for glioblastoma is a maximal resection with functional preservation, followed by radiation and chemotherapy. When temozolomide is used for chemotherapy, the median survival is 14.6 months after initial presentation, 2 and ranges from 5 to 13 months after recurrence. 3,4 Because of the aggressive and invasive nature of the tumor, recurrence is seen in >90% of patients. 5 The most common pattern of recurrence is local regrowth 6 ; therefore, successful local control should lead to prolongation of patients' survival. Various local treatment strategies have been attempted, including repeated operations, conformal radiotherapy, brachytherapy, and local chemotherapy. 7 Although stereotactic radiosurgery (SRS) is an option as salvage treatment for recurrent glioblastoma in clinical settings, the role of SRS is still limited for glioma. SRS is useful in controlling relatively well-demarcated glioma such as ependymoma, pilocytic astrocytoma, and pleomorphic xanthoastrocytoma. [8][9][10][11][12][13] However, the majority of glioma is infiltrative to brain parenchyma and is difficult to target with SRS. A randomized controlle...

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“…Stereotactic radiosurgery (SRS) is appealing due to its ability to deliver a high dose of radiation in a single fraction to the target in a very precise manner [7,8,21,25,43]. Several studies support the idea that patients with recurrent gliomas benefit from SRS [6,16,32,40]. However, SRS is limited to patients with very small tumor volumes compared to other radiotherapeutic techniques and bears a higher risk of radiation necrosis [40].…”

Section: Introductionmentioning

confidence: 99%