Efficacy and Limitations of Stereotactic Radiosurgery in the Treatment of Glioblastoma

Abstract

Treatment of recurrent glioblastoma is still challenging. Stereotactic radiosurgery has been accepted as a treatment option for recurrent glioblastoma after standard chemotherapy and irradiation. However, the efficacy of stereotactic radiosurgery at recurrence has been limited, mainly due to the highly infiltrative nature of the tumor which makes the lesion difficult to define as the target. To enhance the efficacy of stereotactic radiosurgery, several methods of targeting based on neuroimaging technology such as positron emission tomography and magnetic resonance imaging have been adopted to irradiate as many of the viable tumor cells as possible and showed some enhanced efficacy. In a trial of intensified treatment by extending the irradiation field, improvement of local control did not result in longer survival. Radiation-induced adverse event is another problem after stereotactic radiosurgery for recurrent glioblastoma because almost all patients underwent irradiation as a part of the initial treatment. To overcome the side effects associated with re-irradiation, use of bevacizumab, a humanized monoclonal antibody to vascular endothelial growth factor, has shown some efficacy. Advances in irradiation technology, neuroimaging, and adjuvant treatment are needed to enhance the efficacy of stereotactic radiosurgery for recurrent glioblastoma and reduce the morbidity associated with irradiation.

Salvage Radiosurgery for Selected Patients with Recurrent Malignant Gliomas

“…However, due to the low incidence of these tumours, a prospective study is difficult and in clinical practice, patients diagnosed with this entity are not homogeneous and neither is the initial treatment which depends on the medical condition of the patients. You can find the same problem related to the homogeneity of the sample in other published articles [3, 4, 13]. In addition, our series has a large number of patients and the results are in accordance with the literature.…”

“…Recurrence occurs in more than 90% of the patients [3] and its treatment is not clearly established with a median survival of 3–6 months without treatment [4]. Different options of treatment include: repetition of surgical resection, reirradiation with EBRT, brachytherapy or stereotactic radiosurgery (SRS), chemotherapy, novel therapies, or a combination of the above.…”

Upregulation of long noncoding RNA HOXA-AS3 promotes tumor progression and predicts poor prognosis in glioma

“…The median overall survival of Glioblastoma (GBM) which is the most aggressive glioma is less than 15 months, and the 5-year survival rate of patients with GBM is less than 3% [ 2 ]. The progress of treatments for glioma is hampered due to the infiltrative growth and inherent resistance to both chemo and radiotherapy [ 3 ]. To better understand and to find more effective treatments for this disease, it is vital to identify novel biomarkers and therapeutic targets.…”

Comparison of Linear Accelerator and Helical Tomotherapy Plans for Glioblastoma Multiforme Patients

“…But, when re-irradiations are considered, OAR dose constraints gains more importance (Koga and Saito, 2012). Dose constraints of the OAR should be carefully evaluated in the initial irradiation plans and HT seems to have better plans from the aspect of OAR sparing effect.…”