The role of radiotherapy in the management of progressive glioblastoma

Ryu, Samuel; Buatti, John M.; Morris, Ann; Kalkanis, Steven N.; Ryken, Timothy C.; Olson, Jeffrey J.

doi:10.1007/s11060-013-1337-6

Cited by 70 publications

(22 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent glioblastoma practice guidelines stated that level III data supports all re-irradiation modalities, including SRS, for recurrence, but specific patients likely to benefit remain undefined. 49 To our knowledge, this report from over 20 years of institutional experience is the largest single-institution retrospective series of single fraction SRS for recurrent glioblastoma.…”

Section: Discussionmentioning

confidence: 90%

Indications and Efficacy of Gamma Knife Stereotactic Radiosurgery for Recurrent Glioblastoma: 2 Decades of Institutional Experience

Imber

Kanungo²,

Braunstein

et al. 2016

NEUROSURGERY

View full text Add to dashboard Cite

Background The role of stereotactic radiosurgery (SRS) for recurrent glioblastoma and the radionecrosis risk in this setting remain unclear. Objective To perform a large retrospective study to help inform proper indications, efficacy, and anticipated complications of SRS for recurrent glioblastoma. Methods We retrospectively analyzed patients who underwent Gamma Knife SRS between 1991 and 2013. We used the partitioning deletion/substitution/addition (partDSA) algorithm to identify potential predictor covariate cut points and Kaplan-Meier and proportional hazards modeling to identify factors associated with post-SRS and post-diagnosis survival. Results 174 glioblastoma patients (median age 54.1 years) underwent SRS a median of 8.7 months after initial diagnosis. Seventy-five percent had one treatment target (range = 1–6) and median target volume, and prescriptions were 7.0 cm3 (range 0.3–39.0) and 16.0 Gy (range 10–22), respectively. Median overall survival was 10.6 months following SRS and 19.1 months after diagnosis. Kaplan-Meier and multivariable modeling revealed that younger age at SRS, higher prescription dose, and longer interval between original surgery and SRS are significantly associated with improved post-SRS survival. Forty-six patients (26%) underwent salvage craniotomy after SRS, with 63% showing radionecrosis or mixed tumor/necrosis versus 35% showing purely recurrent tumor. The necrosis/mixed group had lower mean isodose prescription compared to the tumor group (16.2 vs 17.8 Gy, P = .0031) and larger mean treatment volume (10.0 vs 5.4 cm3, P = .0091). Conclusion Gamma Knife may benefit a subset of focally recurrent patients, particularly those who are younger with smaller recurrences. Higher prescriptions are associated with improved post-SRS survival and do not seem to have greater risk of symptomatic treatment effect.

show abstract

Section: Discussionmentioning

confidence: 90%

Indications and Efficacy of Gamma Knife Stereotactic Radiosurgery for Recurrent Glioblastoma: 2 Decades of Institutional Experience

Imber

Kanungo²,

Braunstein

et al. 2016

NEUROSURGERY

View full text Add to dashboard Cite

show abstract

“…Glioma is characterized by sustained proliferation, enhanced invasion and migration, and various cytogenetic and molecular abnormalities. To date, surgery [3], followed by radiotherapy [4] and chemotherapy [5], is the standard treatment regimen; however, drug susceptibility has become another intractable problem. Indeed, despite advances in cancer treatment, the prognosis for patients with glioma remains poor and <5% of patients survive for 5 years after diagnosis [3].…”

Section: Introductionmentioning

confidence: 99%

mir-218-2 promotes glioblastomas growth, invasion and drug resistance by targeting CDC27

et al. 2016

View full text Add to dashboard Cite

Glioma has become a significant global health problem with substantial morbidity and mortality, underscoring the importance of elucidating its underlying molecular mechanisms. Recent studies have identified mir-218 as an anti-oncogene; however, the specific functions of mir-218-1 and mir-218-2 remain unknown, especially the latter. The objective of this study was to further investigate the role of mir-218-2 in glioma. Our results indicated that mir-218-2 is highly overexpressed in glioma. Furthermore, we showed that mir-218-2 is positively correlated with the growth, invasion, migration, and drug susceptibility (to β-lapachone) of glioma cells. In vitro, the overexpression of mir-218-2 promoted glioma cell proliferation, invasion, and migration. In addition, the overexpression of mir-218-2 in vivo was found to increase glioma tumor growth. Accordingly, the inhibition of mir-218-2 resulted in the opposite effects. Cell division cycle 27 (CDC27), the downstream target of mir-218-2, is involved in the regulation of glioma cells. Our results indicate that the overexpression of CDC27 counteracted the function of mir-218-2 in glioma cells. These novel findings provide new insight in the application of mir-218-2 as a potential glioma treatment.

show abstract

“…This recommendation is also reflected in two recent clinical practice guidelines (94,95). The available literature suggests that re-irradiation is safe in well selected patients; however, more prospective data are needed to support this conclusion.…”

Section: Resultsmentioning

confidence: 77%

Re-irradiation for Recurrent Primary Brain Tumors

Nieder

Andratschke

Grosu

2016

View full text Add to dashboard Cite

Abstract. Background: Historically, radiation oncologists have been cautious about re-irradiating brain tumors because of concerns about the risks of late central nervous system (CNS) toxicity, especially radionecrosis, that may occur several months to years following treatment. Today there are still limited prospective data addressing this approach. Materials and Methods: Systematic review of published trials reporting clinical results after re-irradiation of patients with different types of brain tumors was performed. Results: Data mainly related to glioblastoma, anaplastic glioma, medulloblastoma, ependymoma and meningioma have been published. Randomized studies are scarce. As in first-line scenarios, efficacy of radiotherapy is influenced by histology. Based on the reported outcomes, preliminary recommendations for dose/fractionation regimens can be given. Conclusion: Re-irradiation of brain tumors is increasingly considered as our understanding of brain tolerance to radiation evolves and developments in radiation technology and imaging make highly accurate targeting of recurrent tumors possible. With developments in systemic therapy, further exploration of the role of re-irradiation on its own or in combination with novel agents is needed.The current postoperative standard treatment for glioblastoma (GBM) is radiotherapy with concurrent and adjuvant temozolomide. With this approach, 5-year overall survival is 9.8% compared to 1.9% with radiotherapy alone (1). Recent data suggest that maintenance therapy with tumor-treating fields in addition to temozolomide improves survival (2). Efforts have been made to standardize the target volume definition (3). Nevertheless, despite an increase in survival rates, the majority of patients progress within 10-15 months. Also for anaplastic astrocytomas and low-grade gliomas, radiotherapy remains a common first-line treatment. In these tumors, the time to progression is longer but the majority ultimately also recurs. Salvage therapy is indicated in the majority of recurrent gliomas and most patients receive systemic therapy and/or surgery at relapse.Historically, many radiation oncologists have been cautious about re-irradiating brain tumors because of concerns about the risks of toxicity, e.g., radionecrosis. Reirradiation for brain tumors is now more frequently used because developments in radiation technology and imaging allow for highly accurate targeting of biologically relevant tumor volumes and, furthermore, several studies have demonstrated the feasibility of this treatment paradigm. This review summarizes radiobiological principles behind reirradiation of different types of brain tumors and discusses the current evidence from clinical studies. Overview of Treatment Options for Recurrent GliomasExternal-beam radiotherapy is an integral part of treatment of low-and high-grade gliomas. At relapse, treatment options have included further surgical resection, systemic therapy, including prospective trials of new agents, and re-irradiation. Currently, however, there is ...

show abstract

The role of radiotherapy in the management of progressive glioblastoma

Abstract: Re-irradiation is recommended in order to maintain or improve a patient's neurological status and quality of life prior to any further tumor progression.

Cited by 70 publications

References 40 publications

Indications and Efficacy of Gamma Knife Stereotactic Radiosurgery for Recurrent Glioblastoma: 2 Decades of Institutional Experience

Indications and Efficacy of Gamma Knife Stereotactic Radiosurgery for Recurrent Glioblastoma: 2 Decades of Institutional Experience

mir-218-2 promotes glioblastomas growth, invasion and drug resistance by targeting CDC27

Re-irradiation for Recurrent Primary Brain Tumors

Contact Info

Product

Resources

About