Salvage therapy in patients with glioblastoma

Hau, Peter; Baumgart, U.; Pfeifer, Katharina; Bock, R N Anne; Jauch, Ralf; Dietrich, Jörg; Fabel, Klaus; Grauer, Oliver; Wismeth, C.; Klinkhammer‐Schalke, Monika; Allgäuer, Michael; Schuierer, Gerhard; Koch, Horst J.; Schlaier, J.; Ulrich, Winfried; Brawanski, Alexander; Bogdahn, Ulrich; Steinbrecher, Andreas

doi:10.1002/cncr.11845

Cited by 67 publications

(50 citation statements)

References 27 publications

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“…Although the effectiveness of individual modes of second-line therapy remains uncertain, treatment of recurrent tumours may confer survival benefit, especially in younger, fitter patients and those with more chemosensitive tumour types. 160,161 Late performance bias confounding survival rates in the BCNU-W trials is therefore a possibility. The impact of treatment order is unknown.…”

Section: Performance Biasmentioning

confidence: 99%

“…Because of this, it is highly plausible that both the incremental costs and incremental survival are partly driven by differing treatment choices during disease progression, rather than the choice of treatment when the gliomas were newly diagnosed. 160,161 An alternative analysis of the cost-effectiveness of TMZ for newly diagnosed high-grade glioma could assume that the effectiveness of treatments for newly diagnosed glioma is restricted to extending PFS. Indeed, there is no good evidence that TMZ, or any other chemotherapy treatment delivered as first-line therapy for newly diagnosed tumours, offers any benefit in slowing the rate of disease progression after recurrence.…”

Section: Illustrative Re-analysismentioning

confidence: 99%

See 1 more Smart Citation

The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation

Garside¹,

Pitt²,

Anderson³

et al. 2007

Health Technol Assess

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Section: Performance Biasmentioning

confidence: 99%

Section: Illustrative Re-analysismentioning

confidence: 99%

The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation

Garside¹,

Pitt²,

Anderson³

et al. 2007

Health Technol Assess

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“…Various local treatment strategies for recurrence have been evaluated to prevent or delay disease progression, including repeated operation, conformal radiotherapy, brachytherapy, and local chemotherapy. 13) Stereotactic radiosurgery has been accepted as another option of salvage treatment for recurrent glioblastoma. 21) However, the highly invasive nature of glioblastoma makes this disease uncontrollable by stereotactic radiosurgery, because this targeted irradiation spares viable cells surrounding the target.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Limitations of Stereotactic Radiosurgery in the Treatment of Glioblastoma

Koga

Saito

2012

Neurol. Med. Chir.(Tokyo)

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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.

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“…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.…”

Section: Introductionmentioning

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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Salvage therapy in patients with glioblastoma

Cited by 67 publications

References 27 publications

The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation

The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation

Efficacy and Limitations of Stereotactic Radiosurgery in the Treatment of Glioblastoma

Extended field stereotactic radiosurgery for recurrent glioblastoma

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