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Stereotactic radiosurgery (SRS) in high-grade glioma: judicious selection of small target volumes improves results

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Abstract

We present a retrospective review of 55 Stereotactic Radiosurgery (SRS) procedures performed in 47 consecutive patients with high-grade glioma (HGG). Thirty-three (70.2 %) patients were diagnosed with glioblastoma and 14 (29.8 %) with grade III glioma. The indications for SRS were small (up to 30 mm in diameter) locally progressing lesions in 32/47 (68 %) or new distant lesions in 15/47 (32 %) patients. The median target volume was 2.2 cc (0.2–9.5 cc) and the median prescription dose was 18 Gy (14–24 Gy). Three patients (5.5 % incidence in 55 treatments) developed radiation necrosis. In eight cases (17 %) patients received a second salvage SRS treatment to nine new lesions detected during follow-up. In 22/55 SRS treatments (40.0 %) patients received concurrent chemo- or biological therapy, including temozolamide (TMZ) (15 patients), bevacizumab (BVZ) (6 patients) and carboplatin in one patient. Median time to progression after SRS was 5.0 months (1.0–96.4). Median survival time after SRS was 15.9 months (2.3–109.3) overall median survival (since diagnosis) was 37.4 months (9.6–193.6 months). Long-lasting responses (>12 months) after SRS were observed in 25/46 (54.3 %) patients. We compared a matched (histology, age, KPS) cohort of patients with recurrent HGG treated with BVZ alone with the current study group. Median survival was significantly longer for SRS treated patients compared to the BVZ only cohort (12.6 vs. 7.3 months, p = 0.0102). SRS may be considered an effective salvage procedure for selected patients with small volume, recurrent high-grade gliomas. Long-term radiological control was observed in more than 50 % of the patients.

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References

  1. Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996

    Article  PubMed  CAS  Google Scholar 

  2. Yazici G, Cengiz M, Ozyigit G, Eren G, Yildiz F, Akyol F, Gurkaynak M, Zorlu F (2014) Hypofractionated stereotactic reirradiation for recurrent glioblastoma. J Neurooncol 120:117–123

    Article  PubMed  Google Scholar 

  3. Patel M, Siddiqui F, Jin J-Y, Mikkelsen T, Rosenblum M, Movsas B, Ryu S (2009) Salvage reirradiation for recurrent glioblastoma with radiosurgery: radiographic response and improved survival. J Neurooncol 92:185–191

    Article  PubMed  Google Scholar 

  4. Martínez-Carrillo M, Tovar-Martín I, Zurita-Herrera M, Del Moral-Ávila R, Guerrero-Tejada R, Saura-Rojas E, Osorio-Ceballos JL, Arrebola-Moreno JP, Expósito-Hernández J (2014) Salvage radiosurgery for selected patients with recurrent malignant gliomas. BioMed Res Int 2014:657953

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hudes RS, Corn BW, Werner-Wasik M, Andrews D, Rosenstock J, Thoron L, Downes B, Curran WJ (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 43:293–298

    Article  PubMed  CAS  Google Scholar 

  6. Fogh SE, Andrews DW, Glass J et al (2010) Hypofractionated stereotactic radiation therapy: an effective therapy for recurrent high-grade gliomas. J Clin Oncol 28:3048–3053

    Article  PubMed  PubMed Central  Google Scholar 

  7. Anand AK, Kumar P, Patir R, Vaishya S, Bansal AK, Chaudhoory AR, Punnakal AU, Malhotra H, Munjal RK (2014) Fractionated stereotactic radiosurgery with volumetric modulated arc therapy (Rapid Arc) for reradiation in recurrent high grade gliomas. J Cancer Res Ther 10:97–102

    Article  PubMed  Google Scholar 

  8. Barani IJ, Larson DA (2015) Radiation therapy of glioblastoma. Cancer Treat Res 163:49–73

    Article  PubMed  Google Scholar 

  9. González DG, Menten J, Bosch DA, van der Schueren E, Troost D, Hulshof MC, Bernier J (1994) Accelerated radiotherapy in glioblastoma multiforme: a dose searching prospective study. Radiother Oncol 32:98–105

    Article  PubMed  Google Scholar 

  10. Werner-Wasik M, Scott CB, Nelson DF, Gaspar LE, Murray KJ, Fischbach JA, Nelson JS, Weinstein AS, Curran WJ (1996) Final report of a phase I/II trial of hyperfractionated and accelerated hyperfractionated radiation therapy with carmustine for adults with supratentorial malignant gliomas. Radiation Therapy Oncology Group Study 83-02. Cancer 77:1535–1543

    Article  PubMed  CAS  Google Scholar 

  11. Souhami L, Seiferheld W, Brachman D et al (2004) Randomized comparison of stereotactic radiosurgery followed by conventional radiotherapy with carmustine to conventional radiotherapy with carmustine for patients with glioblastoma multiforme: report of Radiation Therapy Oncology Group 93-05 protocol. Int J Radiat Oncol Biol Phys 60:853–860

    Article  PubMed  Google Scholar 

  12. Skeie BS, Enger PØ, Brøgger J, Ganz JC, Thorsen F, Heggdal JI, Pedersen P-H (2012) γ knife surgery versus reoperation for recurrent glioblastoma multiforme. World Neurosurg 78:658–669

    Article  PubMed  Google Scholar 

  13. Ogura K, Mizowaki T, Arakawa Y, Sakanaka K, Miyamoto S, Hiraoka M (2013) Efficacy of salvage stereotactic radiotherapy for recurrent glioma: impact of tumor morphology and method of target delineation on local control. Cancer Med 2:942–949

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hall WA, Djalilian HR, Sperduto PW, Cho KH, Gerbi BJ, Gibbons JP, Rohr M, Clark HB (1995) Stereotactic radiosurgery for recurrent malignant gliomas. J Clin Oncol 13:1642–1648

    PubMed  CAS  Google Scholar 

  15. Elaimy AL, Mackay AR, Lamoreaux WT, Demakas JJ, Fairbanks RK, Cooke BS, Lamm AF, Lee CM (2013) Clinical outcomes of gamma knife radiosurgery in the salvage treatment of patients with recurrent high-grade glioma. World Neurosurg 80:872–878

    Article  PubMed  Google Scholar 

  16. Dodoo E, Huffmann B, Peredo I et al (2014) Increased survival using delayed gamma knife radiosurgery for recurrent high-grade glioma: a feasibility study. World Neurosurg 82:e623–e632

    Article  PubMed  Google Scholar 

  17. Macdonald DR, Cascino TL, Schold SC, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280

    PubMed  CAS  Google Scholar 

  18. Ellingson BM, Cloughesy TF, Lai A, Nghiemphu PL, Mischel PS, Pope WB (2011) Quantitative volumetric analysis of conventional MRI response in recurrent glioblastoma treated with bevacizumab. Neuro Oncol 13:401–409

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  19. Weller M, Wick W, von Deimling A (2011) Isocitrate dehydrogenase mutations: a challenge to traditional views on the genesis and malignant progression of gliomas. Glia 59:1200–1204

    Article  PubMed  Google Scholar 

  20. Cardinale R, Won M, Choucair A, Gillin M, Chakravarti A, Schultz C, Souhami L, Chen A, Pham H, Mehta M (2006) A phase II trial of accelerated radiotherapy using weekly stereotactic conformal boost for supratentorial glioblastoma multiforme: RTOG 0023. Int J Radiat Oncol Biol Phys 65:1422–1428

    Article  PubMed  Google Scholar 

  21. Niranjan A, Kano H, Iyer A, Kondziolka D, Flickinger JC, Lunsford LD (2015) Role of adjuvant or salvage radiosurgery in the management of unresected residual or progressive glioblastoma multiforme in the pre-bevacizumab era. J Neurosurg 122:757–765

    Article  PubMed  Google Scholar 

  22. Cho KH, Hall WA, Gerbi BJ, Higgins PD, McGuire WA, Clark HB (1999) Single dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas. Int J Radiat Oncol Biol Phys 45:1133–1141

    Article  PubMed  CAS  Google Scholar 

  23. Gorlia T, Stupp R, Brandes AA et al (2012) New prognostic factors and calculators for outcome prediction in patients with recurrent glioblastoma: a pooled analysis of EORTC Brain Tumour Group phase I and II clinical trials. Eur J Cancer 48:1176–1184

    Article  PubMed  Google Scholar 

  24. Clark GM, McDonald AM, Nabors LB, Fathalla-Shaykh H, Han X, Willey CD, Markert JM, Guthrie BL, Bredel M, Fiveash JB (2014) Hypofractionated stereotactic radiosurgery with concurrent bevacizumab for recurrent malignant gliomas: the University of Alabama at Birmingham experience. Neuro Oncol Pract 1:172–177

    Article  Google Scholar 

  25. Niyazi M, Ganswindt U, Schwarz SB et al (2012) Irradiation and bevacizumab in high-grade glioma retreatment settings. Int J Radiat Oncol Biol Phys 82:67–76

    Article  PubMed  CAS  Google Scholar 

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    Authors and Affiliations

    1. Neuro-Oncology Unit, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel

      Felix Bokstein & Deborah T. Blumenthal

    2. Institute of Radiotherapy, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel

      Benjamin W. Corn, Eliahu Gez, Diana Matceyevsky & Natan Shtraus

    3. Stereotactic Radiosurgery Unit, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel

      Benjamin W. Corn, Eliahu Gez, Diana Matceyevsky, Natan Shtraus & Andrew A. Kanner

    4. Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel

      Zvi Ram & Andrew A. Kanner

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    1. Felix Bokstein
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    2. Deborah T. Blumenthal
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    3. Benjamin W. Corn
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    Correspondence to Andrew A. Kanner.

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    Felix Bokstein and Deborah T. Blumenthal shared first-authorship, equal contributions.

    The authors appreciate the administrative assistance provided by Ms. Meital Hen.

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    Bokstein, F., Blumenthal, D.T., Corn, B.W. et al. Stereotactic radiosurgery (SRS) in high-grade glioma: judicious selection of small target volumes improves results. J Neurooncol 126, 551–557 (2016). https://doi.org/10.1007/s11060-015-1997-5

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    • DOI: https://doi.org/10.1007/s11060-015-1997-5

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