Stereotactic Radiotherapy in Recurrent Glioblastoma: A Valid Salvage Treatment Option

Yaprak, Gökhan; Isik, Naciye; Gemici, Cengiz; Pekyürek, Melike; Bıçakçı, Beyhan Ceylaner; Demircioğlu, Fatih; Tatarlı, Necati

doi:10.1159/000505706

Cited by 15 publications

(10 citation statements)

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“…Park et al [ 47 ] investigated preoperative risk factors for recurrent GBM patients, showing that tumor location near critical structures, poor KPS score, and high tumor volume (≥50 mL) correlated with poor survival after redone surgery. In the study of Yaprak et al, seven re-operated patients before salvage SRT had a significantly poorer OS after SRT compared to un-operated ones ( p = 0.02) [ 34 ]. De Bonis et al reported an increased survival when redone surgery was administered to recurrent GBM; however, the authors reported that patients with a KPS < 70 were significantly at risk of death (HR 2.8— p = 0.001) [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed a survival benefit of SRT compared to observation, reporting an increased OS between 2 to 8 months [ 18 , 30 ]. Kondziolka et al [ 31 ] reported a median OS of 30 months from the time of initial diagnosis in 64 recurrent GBM patients re-irradiated with SRT, while other analyses [ 32 , 33 , 34 ] found a median OS of 8–12.5 months after salvage SRT for recurrent GBM.…”

Section: Discussionmentioning

confidence: 99%

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Radiosurgery and Stereotactic Brain Radiotherapy with Systemic Therapy in Recurrent High-Grade Gliomas: Is It Feasible? Therapeutic Strategies in Recurrent High-Grade Gliomas

Gregucci

Surgo

Carbonara

et al. 2022

JPM

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Purpose. For recurrent high-grade gliomas (HGG), no standard therapeutic approach has been reported; thus, surgery, chemotherapy, and re-irradiation (re-RT) may all be proposed. The aim of the study was to evaluate safety and efficacy of re-RT by radiosurgery or fractionated stereotactic radiotherapy (SRS/FSRT) in association to chemotherapy in patients with recurrent HGG. Material/Methods: All patients with histological diagnosis of HGG that suffered by recurrent disease diagnosed by magnetic resonance imaging (MRI), according to Response Assessment in Neuro-Oncology (RANO) criteria, after primary/adjuvant chemo-radiotherapy treatment and underwent to re-RT by SRS/FSRT were included in the analysis. Second-line chemotherapy was administered. Outcomes were evaluated by neurological examination and brain MRI performed 1 month after re-RT and then every 2–3 months. Results: From November 2019 to September 2021, 30 patients presenting recurrent HGG underwent re-RT. Median dose was 24 Gy (range 15–36 Gy), and median fractions was 5 (range 1–6). Twenty-one patients (70%) had RPA class ≤ IV. One patient had a histological diagnosis of anaplastic oligodendroglioma, 24 patients (80%) were affected by glioblastoma (GBM) including 3 cases of multifocal form, and 5 patients (17%) by anaplastic astrocytoma. Median time between primary/adjuvant RT and disease recurrence was 8 months. In six cases (20%) re-operation was performed, and in most cases (87%), a second line of systemic therapy was administrated. At a median follow-up time from recurrence of 13 months (range 6–56 months), 10 patients (33%) were alive: 2 patients with partial response disease, 7 patients with stable disease, and 1 patient with out-field progression disease. Of the 20 patients who died (67%), 15 (75%) died for progression disease and 5 (25%) for other causes (3 due to septic event, 1 due to thrombo-embolic event, and 1 due to car accident). Median OS and PFS after recurrence were 12.1 and 11.2 months. Six-month and one-year OS were, respectively, 81% and 51%. No acute or late neurological side effects grade ≥ 2 and no case of radio-necrosis were reported. One patient experienced, after reintervention and during Regorafenib treatment (administered 40 days after surgery), dehiscence of the surgical wound. In three cases, grade 2 distal paresthesia was reported. Grade 3–4 hematologic toxicity occurred in seven cases. Three case of grade 5 toxicities during chemotherapy were reported: three septic events and one thrombo-embolic event. Conclusion. Re-RT with SRT/FSRT in association with second-line systemic therapy is a safe and feasible treatment for patients with HGG recurrence. Validation of these results by prospective studies is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiosurgery and Stereotactic Brain Radiotherapy with Systemic Therapy in Recurrent High-Grade Gliomas: Is It Feasible? Therapeutic Strategies in Recurrent High-Grade Gliomas

Gregucci

Surgo

Carbonara

et al. 2022

JPM

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“…The results of our multivariate analysis showed that both beam radiotherapy and chemotherapy can immensely reduce the risk of patients with glioblastoma and improve the survival rate. Yaprak et al ( 29 ) and Liao et al ( 30 ) proved the feasibility of radiotherapy for glioblastoma. In our study, the prognosis of patients with beam radiation therapy was better than with non-beam radiation therapy (including radioactive implants, brachytherapy, radioisotopes, etc.)…”

Section: Discussionmentioning

confidence: 99%

The Nomogram Model Predicting Overall Survival and Guiding Clinical Decision in Patients With Glioblastoma Based on the SEER Database

Huang

et al. 2020

Front. Oncol.

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Background: Patients with glioblastoma have a poor prognosis. We want to develop and validate nomograms for predicting overall survival in patients with glioblastoma. Methods: Data of patients with glioblastoma diagnosed pathologically in the SEER database from 2007 to 2016 were collected by SEER * Stat software. After eliminating invalid and missing clinical information, 3,635 patients (total group) were finally identified and randomly divided into the training group (2,183 cases) and the verification group (1,452 cases). Cox proportional risk regression model was used in the training group, the verification group and the total group to analyze the prognostic factors of patients in the training group, and then the nomogram was constructed. C-indexes and calibration curves were used to evaluate the predictive value of nomogram by internal (training group data) and external validation (verification group data). Results: Cox proportional risk regression model in the training group showed that age, year of diagnosis, laterality, radiation, chemotherapy were all influential factors for prognosis of patients with glioblastoma (P < 0.05) and were all used to construct nomogram as well. The internal and external validation results of nomogram showed that the C-index of the training group was 0.729 [95% CI was (0.715, 0.743)], and the verification group was 0.734 [95% CI was (0.718, 0.750)]. The calibration curves of both groups showed good consistency. Conclusions: The proposed nomogram resulted in accurate prognostic prediction for patients with glioblastoma.

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“…As a consequence, more attention is given to minimally invasive salvage techniques, such as stereotactic radiotherapy (SRT), which represents a viable treatment option, especially in patients with long time-to-recurrence. Recently, Yaprak et al [ 21 ] showed the benefits of SRT in a cohort of 42 patients diagnosed with rGBM following a first-line treatment consisting of resective surgery plus adjuvant TMZ and radiation therapy, who underwent salvage stereotactic treatment. With a median of three fractions at a prescription dose of 20 Gy (range, 18–30), the group was able to demonstrate a statistically significant difference in the survival time between the SRT-treated population (mean, 30 months; range, 9–123) and the patients who could not receive SRT (mean, 14 months; range, 1–111) ( p = 0.001).…”

Section: Locoregional Treatment Of Rgbmmentioning

confidence: 99%

Recurrent Glioblastoma Treatment: State of the Art and Future Perspectives in the Precision Medicine Era

et al. 2022

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Current treatment guidelines for the management of recurrent glioblastoma (rGBM) are far from definitive, and the prognosis remains dismal. Despite recent advancements in the pharmacological and surgical fields, numerous doubts persist concerning the optimal strategy that clinicians should adopt for patients who fail the first lines of treatment and present signs of progressive disease. With most recurrences being located within the margins of the previously resected lesion, a comprehensive molecular and genetic profiling of rGBM revealed substantial differences compared with newly diagnosed disease. In the present comprehensive review, we sought to examine the current treatment guidelines and the new perspectives that polarize the field of neuro-oncology, strictly focusing on progressive disease. For this purpose, updated PRISMA guidelines were followed to search for pivotal studies and clinical trials published in the last five years. A total of 125 articles discussing locoregional management, radiotherapy, chemotherapy, and immunotherapy strategies were included in our analysis, and salient findings were critically summarized. In addition, an in-depth description of the molecular profile of rGBM and its distinctive characteristics is provided. Finally, we integrate the above-mentioned evidence with the current guidelines published by international societies, including AANS/CNS, EANO, AIOM, and NCCN.

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Stereotactic Radiotherapy in Recurrent Glioblastoma: A Valid Salvage Treatment Option

Cited by 15 publications

References 40 publications

Radiosurgery and Stereotactic Brain Radiotherapy with Systemic Therapy in Recurrent High-Grade Gliomas: Is It Feasible? Therapeutic Strategies in Recurrent High-Grade Gliomas

Radiosurgery and Stereotactic Brain Radiotherapy with Systemic Therapy in Recurrent High-Grade Gliomas: Is It Feasible? Therapeutic Strategies in Recurrent High-Grade Gliomas

The Nomogram Model Predicting Overall Survival and Guiding Clinical Decision in Patients With Glioblastoma Based on the SEER Database

Recurrent Glioblastoma Treatment: State of the Art and Future Perspectives in the Precision Medicine Era

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