Gamma Knife Surgery versus Reoperation for Recurrent Glioblastoma Multiforme

Skeie, Bente Sandvei; Enger, Per Øyvind; Brøgger, Jan; Ganz, Jeremy C.; Thorsen, Frits; Heggdal, Jan Ingeman; Pedersen, Paal‐Henning

doi:10.1016/j.wneu.2012.03.024

Cited by 102 publications

(80 citation statements)

References 45 publications

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“…41 Thirty-two patients underwent Gamma Knife SRS, 26 underwent reoperation, and 19 underwent both procedures. These authors showed that patients who underwent SRS had significantly longer survivals than did those who underwent repeat resection.…”

Section: Other Srs Studies For Patients With Glioblastomamentioning

confidence: 99%

Role of adjuvant or salvage radiosurgery in the management of unresected residual or progressive glioblastoma multiforme in the pre–bevacizumab era

Niranjan

Kano

Iyer

et al. 2015

JNS

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abbreviatioNs ARE = adverse radiation effect; GBM = glioblastoma multiforme; KPS = Karnofsky Performance Scale; MST = median survival time; OS = overall survival; PFS = progression-free survival; RPA = recursive partitioning analysis; RT = radiation therapy; RTOG = Radiation Therapy Oncology Group; SRS = stereotactic radiosurgery. obJect After initial standard of care management of glioblastoma multiforme (GBM), relatively few proven options remain for patients with unresected progressive tumor. Numerous reports describe the value of radiosurgery, yet this modality appears to remain underutilized. The authors analyzed the outcomes of early adjuvant stereotactic radiosurgery (SRS) for unresected tumor or later salvage SRS for progressive GBM. Radiosurgery was performed as part of the multimodality management and was combined with other therapies. Patients continued to receive additional chemotherapy after SRS and prior to progression being documented. In this retrospective analysis, the authors evaluated factors that affected patient overall survival (OS) and progression-free survival. methods Between 1987 and 2008 the authors performed Gamma Knife SRS in 297 patients with histologically proven GBMs. All patients had received prior fractionated radiation therapy, and 66% had undergone one or more chemotherapy regimens. Ninety-six patients with deep-seated unresectable GBMs underwent biopsy only. Of those in whom excision had been possible, resection was considered to be gross total in 68 and subtotal in 133. The median patient age was 58 years (range 23-89 years) and the median tumor volume was 14 cm 3 (range 0.26-84.2 cm 3 ). The median prescription dose delivered to the imaging-defined tumor margin was 15 Gy (range 9-25 Gy). The median follow-up duration was 8.6 months (range 1.1-173 months). Cox regression models were used to analyze survival outcomes. Variables examined included age, residual versus recurrent tumor, prior chemotherapy, time to first recurrence, SRS dose, and gross tumor volume. results The median survival times after radiosurgery and after diagnosis were 9.03 and 18.1 months, respectively. The 1-year and 2-year OS after SRS were 37.9% and 16.7%, respectively. The 1-year and 2-year OS after diagnosis were 76.2% and 30.8%, respectively. Using multivariate analysis, factors associated with improved OS after diagnosis were younger age (< 60 years) at diagnosis (p < 0.0001), tumor volume < 14 cm 3 (p < 0.001), use of prior chemotherapy (p = 0.001), and radiosurgery at the time of recurrence (p < 0.0001). Multivariate analysis showed that younger age (p < 0.0001) and smaller tumor volume (< 14 cm 3 ) (p = 0.001) were significantly associated with increased OS after SRS. Adverse radiation effects were seen in 69 patients (23%). Fifty-eight patients (19.5%) underwent additional resection after SRS. The median survivals after diagnosis for recursive partitioning analysis Classes III, IV and V+VI were 31.6, 20.8, and 16.7 months, respectively. coNclusioNs In this analysis 30% of a heterogeneous cohort ...

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Section: Other Srs Studies For Patients With Glioblastomamentioning

confidence: 99%

Role of adjuvant or salvage radiosurgery in the management of unresected residual or progressive glioblastoma multiforme in the pre–bevacizumab era

Niranjan

Kano

Iyer

et al. 2015

JNS

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“…In the present study, RTOG-RPA Class was determined in 95% of patients with the greatest survival advantage appreciated by patients in Class IV: 20.2 months (Table 2) (Figure 4). In prior studies recently reviewed [38], median overall survival for all patients treated with salvage GKRS was from 16.7 to 33.2 months [15,16,18,[30][31][32][33][34][35]. It is also informative to analyze which patient characteristics predict longer survival following salvage therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Factors which historically predict a more favorable prognosis for GBM patients are age less than 50, Karnofsky Performance Status (KPS) of 90 or better, and achieving gross total resection [10][11][12][13][14]. Additional studies have shown an improved prognosis for smaller volume tumors (<15cc), unifocal lesions, use of additional salvage therapies, and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation, and Asian/Pacific Islander ethnicity [15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

“…Some studies have focused on chemotherapeutic salvage options [5,13,[21][22][23], but this relies on a patient's ability to tolerate repeat chemotherapy side effects [24]. Salvage surgical treatment, while effective in select cases [18,25,26], may not be an option for patients suffering from extensive tumors, or those affecting eloquent areas. Recovery from surgery may also be too challenging for a patient and their family during the terminal state of this illness.…”

Section: Introductionmentioning

confidence: 99%

“…Stereotactic radiosurgery has also shown to provide a survival benefit for those in which repeat surgical resection is not indicated [29]. Multiple studies have offered evidence to support a survival benefit for select rGBM patients who receive GKRS salvage treatment [15,16,18,[30][31][32][33][34][35].…”

Section: Introductionmentioning

confidence: 99%

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Case Series: Gamma Knife as Salvage Therapy for Recurrent Glioblastoma Multiforme

Larson¹,

Peterson²,

Lamoreaux³

et al. 2014

Brain Disord Ther

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Objectives: Glioblastoma multiforme is a highly malignant primary tumor of the brain. It has a dismal survival prognosis of 14-16 months following initial diagnosis. Despite aggressive upfront therapy, glioblastoma tends to recur in twelve months. Following this recurrence, some patients may benefit from Gamma Knife Radiosurgery (GKRS) treatment. This study analyzes survival outcomes in a case series by studying known prognostic indicators for glioblastoma patients.Methods: 63 patients with recurrent glioblastoma were treated with GKRS as part of a multimodal treatment plan between 2002 and 2011. Overall survival (from date of diagnosis) was compared to expected survival times as indicated by updated RTOG recursive partitioning analysis (RTOG-RPA) Classes. Survival post-GKRS salvage was also investigated. Univariate and multivariate analyses were conducted to determine whether there were significant predictors of overall survival for patients undergoing GKRS salvage. Results:Overall median survival from time of initial diagnosis was 20.2 ± 2.7 months for the entire group. 46 patients were in RTOG-RPA Class IV with a median overall survival of 20.2 ± 2.6 months (expected prognosis: 11.2 months). Median survival following GKRS salvage therapy was 9.9 ± 3.1 months for all patients. Multivariate analysis indicated that KPS was a significant predictor of survival (Hazard Ratio 0.22 compared to a KPS of 80).Conclusions: GKRS may be a safe and effective salvage therapy for selected recurrent glioblastoma patients, providing prolonged survival and quality of life compared to patients not receiving salvage treatment. Treatment options should be appropriately tailored to each patient's individual situation.

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Evaluation of inverse treatment planning for gamma knife radiosurgery using fMRI brain activation maps as organs at risk

Abramian,

Blystad,

Eklund

2023

Medical Physics

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BackgroundStereotactic radiosurgery (SRS) can be an effective primary or adjuvant treatment option for intracranial tumors. However, it carries risks of various radiation toxicities, which can lead to functional deficits for the patients. Current inverse planning algorithms for SRS provide an efficient way for sparing organs at risk (OARs) by setting maximum radiation dose constraints in the treatment planning process.PurposeWe propose using activation maps from functional MRI (fMRI) to map the eloquent regions of the brain and define functional OARs (fOARs) for Gamma Knife SRS treatment planning.MethodsWe implemented a pipeline for analyzing patient fMRI data, generating fOARs from the resulting activation maps, and loading them onto the GammaPlan treatment planning software. We used the Lightning inverse planner to generate multiple treatment plans from open MRI data of five subjects, and evaluated the effects of incorporating the proposed fOARs.ResultsThe Lightning optimizer designs treatment plans with high conformity to the specified parameters. Setting maximum dose constraints on fOARs successfully limits the radiation dose incident on them, but can have a negative impact on treatment plan quality metrics. By masking out fOAR voxels surrounding the tumor target it is possible to achieve high quality treatment plans while controlling the radiation dose on fOARs.ConclusionsThe proposed method can effectively reduce the radiation dose incident on the eloquent brain areas during Gamma Knife SRS of brain tumors.

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Gamma Knife Surgery versus Reoperation for Recurrent Glioblastoma Multiforme

Cited by 102 publications

References 45 publications

Role of adjuvant or salvage radiosurgery in the management of unresected residual or progressive glioblastoma multiforme in the pre–bevacizumab era

Role of adjuvant or salvage radiosurgery in the management of unresected residual or progressive glioblastoma multiforme in the pre–bevacizumab era

Case Series: Gamma Knife as Salvage Therapy for Recurrent Glioblastoma Multiforme

Evaluation of inverse treatment planning for gamma knife radiosurgery using fMRI brain activation maps as organs at risk

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