Radiosurgery for recurrent glioblastoma: a review article

Abstract

Glioblastoma (GB) is the most common primary brain tumor in adults, accounting for more than half of all diffuse gliomas with an agressive disease course despite multimodality management. Too few patients with GB live more than 5 years, and there are several prognostic factors including age, performance status, and MGMT promoter methylation which is associated with response to Temozolomide treatment. Standard of care in newly diagnosed GB has been established in 2005 as concurrent chemoradiotherapy, based on the landmark European Organisation for Research and Treatment of Cancer (EORTC)/National Cancer Institute of Canada Clinical Trials Group (NCIC-CTG) study demonstrating a clinically meaningful and significant median overall survival benefit with the addition of Temozolomide to conventionally fractionated partial brain radiotherapy. However, recurrence is very common in an overwhelming majority of the patients with a grim prognosis. Several therapeutic strategies are employed in the recurrent setting with no established standard of care. Reoperation, repeat radiotherapy, chemotherapy, tumor treating fields, antiangiogenic and other targeted agents, experimental treatments and combinations of modalities have been used for management of patients with recurrent GB depending on tumor and patient characteristics. Herein, we review the use of radiosurgery for management of recurrent GB in light of the literature.

Evaluation of Radiosurgery Target Volume Determination for Meningiomas Based on Computed Tomography (CT) And Magnetic Resonance Imaging (MRI)

“…Stereotactic Body Radiation Therapy (SBRT) has emerged as a viable radiotherapeutic modality for management several benign and malign tumors throughout the human body including meningiomas, brain metastases, arteriovenous malformations, pituitary adenomas, vestibular schwannomas, cerebral cavernous malformations, craniopharyngiomas, glomus jugulare tumors, pulmonary oligometastases, and recurrent glioblastomas [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Evaluation of the Impact of Magnetic Resonance Imaging (MRI) on Gross Tumor Volume (GTV) Definition for Radiation Treatment Planning (RTP) of Inoperable High Grade Gliomas (HGGs)

“…GB, the most common primary brain tumor in adults, remains to be a formidable challenge to the treating physicians with a dismal prognosis despite multimodality management [2,3]. Several studies have focused on strategies for improving the poor outcome in the setting of newly diagnosed or recurrent disease by use of dose escalation, radiosensitization, immunotherapy, radiosurgery, and evolving intensified treatment approaches [4][5][6][7][8][9][10]. Maximal surgical removal of the tumor followed by chemoradiotherapy has been the standard of care for newly diagnosed GB patients after the landmark trial of European Organisation for Research and Treatment of Cancer (EORTC)/National Cancer Institute of Canada Clinical Trials Group (NCIC-CTG) in 2005 and has been widely practiced worldwide [11].…”

Multimodality Imaging for Radiosurgical Management of Arteriovenous Malformations

“…In this context, microvascular surgical resection, endovascular embolization and radiosurgical treatment may be used for management of AVMs. Stereotactic Radiosurgery (SRS) has been utilized for management of several benign and malign indications with considerable success [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. In the context of AVMs, surgery offers effective management of AVMs in selected patients, however, radiosurgery may be considered when there may be an excessive risk of surgical complications for deep-seated lesions located at eloquent brain regions.…”