Survival following stereotactic radiosurgery for newly diagnosed and recurrent glioblastoma multiforme: a multicenter experience

Abstract

Despite decades of clinical trials investigating new treatment modalities for glioblastoma multiforme (GBM), there have been no significant treatment advances since the 1980s. Reported median survival times for patients with GBM treated with current modalities generally range from 9 to 19 months. The purpose of the current study is to retrospectively review the ability of CyberKnife (Accuray Incorporated, Sunnyvale, CA, USA) radiosurgery to provide local tumor control of newly diagnosed or recurrent GBM. Twenty patients (43.5%) underwent CyberKnife treatment at the time of the initial diagnosis and/or during the first 3 months of their initial clinical management. Twenty-six patients (56.5%) were treated at the time of tumor recurrence or progression. CyberKnife was performed in addition to the traditional therapy. The median survival from diagnosis for the patients treated with CyberKnife as an initial clinical therapy was 11.5 months (range, 2-33) compared to 21 months (range, 8-96) for the patients treated at the time of tumor recurrence/progression. This difference was statistically significant (Kaplan-Meier analysis, P = 0.0004). The median survival from the CyberKnife treatment was 9.5 months (range, 0.25-31 months) and 7 months (range, 1-34 months) for patients in the newly diagnosed and recurrent GBM groups (Kaplan-Meier analysis, P = 0.79), respectively. Cox proportional hazards survival regression analysis demonstrated that survival time did not correlate significantly with treatment parameters (Dmax, Dmin, number of fractions) or target volume. Survival time and recursive partitioning analysis class were not correlated (P = 0.07). Patients with more extensive surgical interventions survived longer (P = 0.008), especially those who underwent total tumor resection vs. biopsy (P = 0.004). There is no apparent survival advantage in using CyberKnife in initial management of glioblastoma patients, and it should be reserved for patients whose tumors recur or progress after conventional therapy.

Salvage Radiosurgery for Selected Patients with Recurrent Malignant Gliomas

“…The median post-SRS survival varies between 6.5 months [25] and 26 months [13]. These differences may be due to the inhomogeneity among the studies (clinical features of the patients, histological type, modalities of treatment after SRS, and so forth).…”

Advances in Diagnostic and Treatment Modalities for Intracranial Tumors

“…SRT has become widely used for the treatment of nonresectable intracranial masses, either intraaxial or involving the skull base. Experience with skull base meningiomas and gliomas in humans suggests responses may approach those seen with surgically resected tumors 185, 186. One of the major advantages of SRT techniques is the ability to deliver the therapeutic dose of radiation in 2–5 fractions (single dose treatments are referred to as stereotactic radiosurgery [SRS]) compared to 16–20 fractions for standard radiation protocols.…”

Increased migration of a human glioma cell line after in vitro CyberKnife irradiation

“…In a recently published multicenter study, SRS with CK treatment was well tolerated although the median survival time did not exceed 7 mo (range, 1-34 mo) in patients with recurrent GBM. 5 While the antiproliferative effects of irradiation on glioma cells have been extensively studied, little is known about the effects of ionizing radiation on migration/invasion of GBM cells and even less is known about potential differences in biological effects between different SRS irradiation modality. It has previously been reported that in vitro cultured GBM cells may increase their migration/invasion ability after irradiation.…”