Re-Irradiation with Stereotactic Radiosurgery/Radiotherapy for Recurrent High-Grade Gliomas: Improved Survival in the Modern Era

Stereotact Funct Neurosurg. 2018;96(5):289-295. doi: 10.1159/000493545. Epub 2018 Nov 7.

Abstract

Objective: The aim of this study was to evaluate the efficacy of stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) as salvage therapy for recurrent high-grade glioma and to look at the overall efficacy of treatment with linear accelerator (LINAC)-based radiosurgery and fractionated radiotherapy.

Methods: From 2010 to 2017, a total of 25 patients aged 23-74 years were re-irradiated with LINAC-based SRS and fSRT. Patients were treated to a median dose of 25 Gy in 5 fractions.

Results: The median overall survival (OS) after (initial) diagnosis was 39 months with an actuarial 1-, 3-, and 5-year OS rate of 88, 56, and 30%, respectively. After treatment with SRS or fSRT, the median OS was 9 months with an actuarial 1-year OS rate of 29%. Local control, assessed for 28 tumors, after 6 months was 57%, while local control after 1 year was 39%. Three patients experienced local failure. There was no evidence of toxicity noted after SRS or fSRT throughout the follow-up period.

Conclusion: SRS and fSRT remain a safe, reasonable, effective treatment option for re-irradiation following recurrent glioblastoma. Additionally, treatment volume may predict local control in the salvage setting.

Keywords: Glioblastoma multiforme; Stereotactic radiosurgery; Stereotactic radiotherapy.

MeSH terms

  • Adult
  • Aged
  • Brain Neoplasms / diagnostic imaging
  • Brain Neoplasms / mortality
  • Brain Neoplasms / radiotherapy*
  • Female
  • Glioblastoma / diagnostic imaging
  • Glioblastoma / mortality
  • Glioblastoma / radiotherapy*
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / radiotherapy*
  • Radiosurgery / adverse effects
  • Radiosurgery / methods*
  • Radiosurgery / mortality
  • Re-Irradiation / adverse effects
  • Re-Irradiation / methods*
  • Re-Irradiation / mortality
  • Retrospective Studies
  • Salvage Therapy / mortality
  • Salvage Therapy / trends
  • Survival Rate / trends
  • Treatment Outcome
  • Young Adult