The Emerging Role of Stereotactic Radiosurgery in the Treatment of Glioblastoma Multiforme

Abstract

Stereotactic radiosurgery is an emerging treatment option offered to patients with Glioblastoma multiforme (GBM). Radiosurgery is performed as an outpatient procedure and provides a safe and effective non invasive treatment for focal GBM. High energy beams originating from cobalt sources placed into an helmet (Gamma-Knife) or generated by a linear accelerator (LINAC) rotating on a gantry (X-Knife, Novalis) or maneuvered by a robotic arm (CyberKnife) are delivered with submillimetric accuracy to a selected intracranial target. Treatment accuracy is provided by image-guided volumetric CT and MR studies complemented with advanced metabolic neuroimaging techniques such as CT-PET. Radiosurgery is typically used as a salvage treatment in patients with recurrent GBM to avoid further surgical procedures or as a complement to conventional fractionated radiotherapy. This paper reviews the emerging role of stereotactic radiosurgery in the treatment of GBM.

Staged Image-guided Robotic Radiosurgery and Deferred Chemotherapy to Treat a Malignant Glioma During and After Pregnancy

“…Gross tumor volume less than 10.1 cm 3 was associated with a median survival of 15.1 months versus 8.1 months for larger tumors. The role of CyberKnife SRS in the treatment of GBM was recently reviewed by Barbarisi et al; the authors highlighted the value of accurate high-dose treatment either in single or multiple sessions [ 10 ]. The combination of sophisticated real-time image and robotic delivery is the basis of the CyberKnife’s precision and submillimetric accuracy and it can be employed as a primary treatment modality in patients harboring small lesions (3 cm or less in diameter), lesions located in surgically inaccessible regions, such as the thalamus, hypothalamus, and basal ganglia, or in the patients that are too ill for a surgical resection.…”

Combined Salvage Therapies for Recurrent Glioblastoma Multiforme: Treatment Options in Multifocal and Multicentric Patterns of Recurrence

“…The addition of stereotactic radiosurgery in combination to chemotherapy could have beneficial effects. Previous studies show the effectiveness of fractionated stereotactic radiosurgery (FSRS) as an option for the treatment of recurrent glioblastoma [27,28]. Combs et al reported 5 months progression-free survival after FSRT and 21 months median overall survival [29].…”

“…In our hands HDR-Brachytherapy is an approved treatment method of recurrent high grade gliomas. It offers a potential advantage over the conventional interstitial brachytherapy by means of delivering a more conformal, uniform and relatively homogeneous dose distribution, avoiding the "hot" and "cold" spots of over-and under-dosing of seed or strand brachytherapy approaches [27]. Furthermore, the catheters and subsequent treatment planning conform to the surgical cavity, and the dosimetry is precise and easily reproduced.…”