Hypofractionated stereotactic re-irradiation: treatment option in recurrent malignant glioma

Vordermark, Dirk; Kölbl, Oliver; Ruprecht, Klemens; Vince, Giles Hamilton; Bratengeier, Klaus; Flentje, Michael

doi:10.1186/1471-2407-5-55

Cited by 141 publications

(109 citation statements)

References 13 publications

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“…Obviously, radiation therapy, including SRS, and temozolomide are not sufficient to control the disease. New approaches are underway, including monoclonal antibodies that target specific molecules, for example, bevacizumab, 31,32 and oncolytic viruses that replicate selectively in tumor cells. 33 In conclusion, extended field SRS was well tolerated and superior to conventional SRS in the local control of small recurrent lesions of glioblastoma, although a further device to suppress remote recurrences may be necessary to improve survival.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

Extended field stereotactic radiosurgery for recurrent glioblastoma

Koga

Maruyama

Tanaka

et al. 2011

Cancer

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“…Fogh et al found that patients with GBM treated with HFSRT of 35 Gy at 3.5 Gy per fraction had a median survival of 8 months from the start of treatment [23]. In another study, patients receiving RT with 30 Gy in 5 fractions had a median OS of 7.9 months after re-RT [24]. Ciamella et al found that the median OS was 9.5 months in a HFSRT study with 25 Gy administered in 5 fractions [25].…”

Section: Discussionmentioning

confidence: 95%

Concurrent hyperthermia and re-irradiation for recurrent high-grade gliomas

Heo¹,

Kim²,

Oh³

et al. 2017

neo

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Salvage therapy for recurrent high grade gliomas (HGG) includes surgery, radiotherapy and chemotherapy, however, standard treatment does not exist. We evaluated the tolerability and efficacy of re-irradiation (re-RT) with hyperthermia (HT) for patients with recurrent HGG. From September 2010 to July 2015, 20 patients with recurrent HGG were treated with re-RT and HT. The radiotherapy dose of 30 Gray (Gy) was delivered with 2 Gy per fraction daily, and HT was performed twice weekly. Primary endpoints were treatment compliance and toxicity. Second endpoints were overall survival (OS) and progression free survival (PFS). The median interval between initial RT and re-RT was 11 months. During re-RT with HT, there were no significant acute morbidities over grade 3. Median overall survival (OS) from re-irradiation was 8.4 months and the 6 and 12 months survival rate were 67% and 30%, respectively. The median progression free survival (PFS) from re-irradiation was 4.1 month. Our findings suggested that concurrent re-RT with HT was a safe and well-tolerated. In addition, the combination re-RT and HT could be a valuable salvage treatment option for selected recurrent HGG patients with poor performance status.

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“…Of these, HFSRT has emerged as a noninvasive method to deliver a high dose of radiation to the tumor site. In the treatment of recurrent GBM, numerous studies have documented a survival advantage on the use of HFSRT [10][11][12][13][14][15][16][17][18] and HFSRT in combination with chemotherapy [19][20][21][22][23][24]. Specifically, Iuchi, et al [25] has shown that a single dose of more than 20 Gy is able to achieve durable local control in 72% of patients; however, radiation necrosis (RN) was observed in 43% of patients.…”

Section: Introductionmentioning

confidence: 99%