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Journal of Neuro-Oncology

, Volume 82, Issue 3, pp 297–303 | Cite as

Fractionated stereotactic radiotherapy using gamma unit after hyperbaric oxygenation on recurrent high-grade gliomas

  • Kiyotaka KohshiEmail author
  • Haruaki Yamamoto
  • Ai Nakahara
  • Takahiko Katoh
  • Masashi Takagi
CLINICAL-PATIENT STUDIES

Abstract

Background

To reduce this complication and to enhance the radiation effect to hypoxic cells of high-grade gliomas, the authors performed noninvasive fractionated stereotactic radiotherapy (FSRT) using a Gamma unit combined with hyperbaric oxygen (HBO) therapy for the treatment of recurrent disease.

Patients and methods

Twenty-five consecutive patients who had previously received radiotherapy with chemotherapy for recurrent high-grade gliomas, including 14 patients with anaplastic astrocytoma (AA) and 11 with glioblastoma multiforme (GBM), underwent Gamma FSRT immediately after HBO therapy (2.5 atmospheres absolute for 60 min). The Gamma FSRT was repeatedly performed using a relocatable head cast. Median tumor volume was 8.7 cc (range, 1.7–159.3 cc), and the median total radiation dose was 22 Gy (range, 18–27 Gy) to the tumor margin in 8 fractions.

Results

Actuarial median survival time after FSRT was 19 months for patients with AA and 11 months for patients with GBM, which was significantly different (P = 0.012, log-rank test). Two patients underwent subsequent second FSRT for regional or remote recurrence. Seven patients (28%) underwent subsequent craniotomies and resections at a mean of 8.4 months after FSRT treatment, and 4 of them had radiation effects without viable cells and remained alive for 50–78 months.

Conclusion

Gamma FSRT after HBO therapy appears to confer a survival benefit for patients with recurrent high-grade gliomas and warrants further investigation.

Keywords

Recurrent gliomas Stereotactic radiotherapy Fractionation Gamma Knife Hyperbaric oxygenation 

References

  1. 1.
    Larson DA, Gutin PH, McDermott M et al. (1996) Gamma knife for glioma: selection factors and survival. Int J Radiat Oncol Biol Phys 36:1045–1053PubMedCrossRefGoogle Scholar
  2. 2.
    Cho KH, Hall WA, Gerbi BJet al. (1999) Single dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas. Int J Radiat Oncol Biol Phys 45:1133–1141PubMedCrossRefGoogle Scholar
  3. 3.
    Hudes RS, Corn BW, Werner-Wasik M et al. (1999) A phase I dose escalation study of hypofractionated stereotactic radiotherapy as salvage therapy for persistent or recurrent malignant glioma. Int J Radiat Oncol Biol Phys 43:293–298PubMedCrossRefGoogle Scholar
  4. 4.
    Shepherd SF, Laing RW, Cosgrove VP et al. (1997) Hypofractionated stereotactic radiotherapy in the management of recurrent glioma. Int J Radiat Oncol Biol Phys 37:393–398PubMedCrossRefGoogle Scholar
  5. 5.
    Kohshi K, Kinoshita Y, Imada H et al. (1999) Effects of radiotherapy after hyperbaric oxygenation on malignant gliomas. Br J Cancer 80:236–241PubMedCrossRefGoogle Scholar
  6. 6.
    Ogawa K, Yoshii Y, Inoue O et al. (2003) Prospective trial of radiotherapy after hyperbaric oxygenation with chemotherapy for high-grade gliomas. Radiother Oncol 67:63–67PubMedCrossRefGoogle Scholar
  7. 7.
    Kleihues P, Burger PC, Scheithauer BW (1993) Histological Typing of Tumours of the Central Nervous System 2nd Ed. Springer-Verlag, BerlinGoogle Scholar
  8. 8.
    Yamamoto H, Takagi M, Ushio Y, Ohno S. (1998) Gamma knife radiosurgery for multiple metastatic brain lesions Neurosurg Lett 8:391–398 (in Japanese, no English abstract)Google Scholar
  9. 9.
    Simonova G, Novotny J, Novotny J Jr et al. (1995) Fractionated stereotactic radiotherapy with the Leksell Gamma Knife: feasibility study. Radiother Oncol 37:108–116PubMedCrossRefGoogle Scholar
  10. 10.
    Kaplan EL, Meier P (1958) Non-parametric estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRefGoogle Scholar
  11. 11.
    Mantel N (1966) Evaluation of survival data, two new rank order statistics arising in its consideration. Cancer Chemother Rep 50:163–170PubMedGoogle Scholar
  12. 12.
    Wallner KE, Galicich JH, Krol G et al. (1989) Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 16:1405–1409PubMedGoogle Scholar
  13. 13.
    Patel S, Breneman JC, Warnick RE et al. (2000) Permanent iodine-125 interstitial implants for the treatment of recurrent glioblastoma multiforme. Neurosurgery 46:1123–1128PubMedCrossRefGoogle Scholar
  14. 14.
    Simon JM, Cornu P, Boisserie G et al. (2002) Brachytherapy of glioblastoma recurring in previously irradiated territory: predictive value of tumor volume. Int J Radiat Oncol Biol Phys 53:67–74PubMedCrossRefGoogle Scholar
  15. 15.
    Shrieve DC, Alexander III E, Wen PY et al. (1995) Comparison of stereotactic radiosurgery and brachytherapy in the treatment of recurrent glioblastoma multiforme. Neurosurgery 36:275–284PubMedCrossRefGoogle Scholar
  16. 16.
    Kondziolka D, Flickinger JC, Bissonette DJ et al. (1997) Survival benefit of stereotactic radiosurgery for patients with malignant glial neoplasms. Neurosurgery 41:776–785PubMedCrossRefGoogle Scholar
  17. 17.
    Inoue HK, Hayashi S, Ishihara J et al. (1995) Fractionated Gamma Knife radiosurgery for malignant gliomas: neuroimaging effects and FDG-PET studies. Stereotact Funct Neurosurg 64(suppl 1):249–257PubMedGoogle Scholar
  18. 18.
    Regine WF, Patchell RA, Strottmann JM et al. (2000) Preliminary report of a phase I study of combined fractionated stereotactic radiosurgery and conventional external beam radiation therapy for unfavorable gliomas. Int J Radiat Oncol Biol Phys 48:421–426PubMedCrossRefGoogle Scholar
  19. 19.
    Miranpuri AS, Tome WA, Paliwal BR et al. (2001) Assessment of patient-independent intrinsic error for a noninvasive frame for fractionated stereotactic radiotherapy. Int J Cancer (Radiat Oncol Invest) 96:320–325CrossRefGoogle Scholar
  20. 20.
    Fowler JF. (1989) The linear-quadratic formula, progress in fractionated radiotherapy. Br J Radiol 62:679–694PubMedCrossRefGoogle Scholar
  21. 21.
    Hall EJ (1994) Radiobiology for the Radiologists. Philadelphia, Lippincott, pp 133–152Google Scholar
  22. 22.
    Rampling R, Cruickshank G, Lewis AD et al. (1994) Direct measurement of pO2 distribution and bioreductive enzymes in human malignant brain tumors. Int J Radiat Oncol Biol Phys 29:427–431PubMedGoogle Scholar
  23. 23.
    Collingridge DR, Piepmeier JM, Rockwell S, Knisely. (1999) Polarographic measurements of oxygen tension in human glioma, surrounding peritumoural brain tissue. Radiother Oncol 53:127–131Google Scholar
  24. 24.
    Kunugita N, Kohshi K, Kinoshita Y, et al. (2001) Radiotherapy after hyperbaric oxygenation improves radioresponse in experimental tumor model. Cancer Lett 164:149–154PubMedCrossRefGoogle Scholar
  25. 25.
    Kinoshita Y, Kohshi K, Kunugita N et al. (2000) Preservation of tumour oxygen after hyperbaric oxygenation monitored by magnetic resonance imaging. Br J Cancer 82:88–92PubMedCrossRefGoogle Scholar
  26. 26.
    Beppu T, Kamada K, Yoshida Y et al. (2002) Change of oxygen pressure in glioblastoma tissue under various conditions. J Neurooncol 58:47–52PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Kiyotaka Kohshi
    • 1
    Email author
  • Haruaki Yamamoto
    • 2
  • Ai Nakahara
    • 3
  • Takahiko Katoh
    • 3
  • Masashi Takagi
    • 2
  1. 1.Division of Hyperbaric Medicine and Department of NeurosurgeryUniversity Hospital of Occupational and Environmental HealthKitakyushuJapan
  2. 2.Division of Gamma Knife CenterFukuoka Wajiro HospitalFukuokaJapan
  3. 3.Department of Public Health, School of MedicineMiyazaki UniversiryMiyazakiJapan

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