Journal of Radiosurgery

, Volume 2, Issue 3, pp 119–125 | Cite as

Recurrent Malignant Gliomas Treated with Radiosurgery

  • Seema Sanghavi
  • Ryan Skrupky
  • Behnam Badie
  • Ian Robins
  • Wolfgang Tome
  • Minesh P. Mehta


The inability to control malignant glioma results in a high incidence of local failure and poor survival. Focal therapy such as radiosurgery permits delivery of a high dose of radiation with moderate toxicity. This report summarizes the outcome of patients with recurrent malignant glioma treated with radiosurgery at University of Wisconsin Hospital, between January 1989 and December 1997, when 30 patients were treated radiosurgically. All patients had undergone and failed external beam radiotherapy (median dose of 59.4 Gy) prior to radiosurgery. All recurrences were detected by clinical deterioration and confirmed by radiographic progression. No patient was treated for radiographic progression only in the context of a screening protocol. Eight out of 30 patients underwent subtotal resection prior to radiosurgery and 3 received chemotherapy along with radiosurgery. Radiosurgery was delivered in a single fraction using a modified linear accelerator. The median tumor volume was 7.2 cm3 (range 0.42–35.1 cm3) and the median minimal tumor dose was 12 Gy at the 50–80% isodose line. Median follow-up is 70 months. The median overall survival is 8 months; the 1- and 2-year survival rates are 20% and 9%, respectively. For patients with an initial diagnosis of non-glioblastoma, the median survival is 11 months and for those with glioblastoma the median survival is 7 months. The median progression-free survival is 4 months for the entire cohort, 5 months for nonglioblastoma, and 3 months for glioblastoma. The 1-year actuarial reoperation rate after radio-surgery is 7.6%. Radiosurgery for recurrent malignant glioma may improve short-term survival for selected patients with a lower reoperation rate than brachytherapy.

Radiosurgery malignant glioma surgery brachytherapy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Landis S, Murray T, Bolden S, Wingo PA: Cancer statistics, 1998. CA: A Cancer Journal for Clinicans 48:6–31, 1998Google Scholar
  2. 2.
    Levin VA, Edwards MS, Wright DC, Sealer ML, Pischer TL, Townsend JT, Wilson CB: Modified procarbazine, CCNU, and vincristine (PCV) combination chemotherapy in the treatment of malignant brain tumors. Cancer Treat Rep 64:237–241, 1980Google Scholar
  3. 3.
    Leibel SA, Scott CB, Loeffler JS: Contemporary approaches to the treatment of malignant gliomas with radiation therapy. Semin Oncol 21:198, 1994Google Scholar
  4. 4.
    Wallner KE, Galicich JH, Krol G, Arbit E, Malkin MG: Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 16:1405–1409, 1989.Google Scholar
  5. 5.
    Vertosick PT, Jr, Selker RG: Brainstem and spinal metastases of supratentorial glioblastoma multiforme: A clinical series. Neurosurgry 27:516–522, 1990Google Scholar
  6. 6.
    Dirks P, Bernstein M, Muller PJ, Tucker WS: The value of reoperation for recurrent glioblastoma. CJS 36:271–275, 1993Google Scholar
  7. 7.
    Young B, Oldfield EH, Markesbery WR, Haack D, Tibbs PA, McCombs P, Chin HW, Maruyama Y, Meacham WF: Reoperation for glioblastoma. J Neurosurg 55:917–921, 1981Google Scholar
  8. 8.
    Walker MD, Strike TA, Sheline GE: An analysis of dose-effect relationship in the radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys 5:1725–1731, 1979Google Scholar
  9. 9.
    Scharfen CO, Sneed PK, Wara WM, Larson DA, Phillips TL, Prados MD, Weaver KA, Malec M, Acord P, Lamborn KR, Lamb SA, Ham B, Gutin PH: High activity iodine-125 interstitial implant for gliomas. Int J Radiat Oncol Biol Phys 24:583–591, 1992Google Scholar
  10. 10.
    Gutin PH, Leibel SA, Wara WM, Choucair A, Levin VA, et al.: Recurrent malignant gliomas; survival following interstitial brachytherapy with high-activity iodine-125 sources. J Neurosurg 67:864–873, 1987Google Scholar
  11. 11.
    Lucas GL, Luxton G, Cohen D, Petrovich Z, Langholz B, Apuzzo MLJ, Sapozink MD: Treatment results of stereotactic interstitial brachytherapy for primary and metastatic brain tumors. Int J Radiat Oncol Biol Phys 21:715–721, 1991Google Scholar
  12. 12.
    Shrieve DC, Alexander E, Wen PY, Fine HA, Kooy HM, Black PM, Loeffler JS: Comparison of sterotactic radiosurgery and brachytherapy in the treatment of recurrent glioblastoma multiforme. Neurosurgery 361:275–282, 1995Google Scholar
  13. 13.
    Mehta MP, Rozenthal JM, Levin AB, Mackie TR, Kubad SS, Gehring MA, et al.: Defining the role of stereotactic, radiosurgery in the management of brain metastases. Int J Radiat Oncol Biol Phys 24:619–625, 1992Google Scholar
  14. 14.
    Gehring MA, Mackie TR, Kubsad SS, Paliwal BR, Mehta MP, Kinsella TJ: A three-dimensional volume visualization package applied to stereotactic radiosurgery treatment planning. Int J Radiat Oncol Biol Phys 21:491–500, 1991Google Scholar
  15. 15.
    Kubsad SS, Mackie TR, Gehring MA, Paliwal BR, Mehta MP, Kinsella TJ: Monte Carlo and convolution dosimetry for stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 19:1027–1035, 1990Google Scholar
  16. 16.
    Kaplan EL, Meier P: Non-parametric estimation from incomplete observation. J Am Stat Assoc 53:457–481, 1958Google Scholar
  17. 17.
    Chamberlain MC, Barba D, Kormanik P, Shea WM: Sterotactic radiosurgery for recurrent gliomas. Cancer 74:1342–1347, 1994Google Scholar
  18. 18.
    Hall WA, Djalilian HR, Sperduto PW, Cho KH, Gerbi BJ, Gibbons JP, Rohr M, Clark HB: Stereotactic radiosurgery for recurrent malignant gliomas. J Clin Oncol 13:1642–1648, 1995Google Scholar
  19. 19.
    Larson DA, Gutin PH, McDermott M, Lamborn K, Sneed PK, Wara WM, Flickinger JC, Kondziolka D, Lunsford LD, Hudgins WR, Friehs GH, Haselsberger K, Leber K, Pendl G, Chung SS, Coffey RJ, Dinapoli R, Shaw EG, Vermeulen S, Young RF, Hirato M, Inoue HK, Ohye C, Shibazaki T: Gamma knife for glioma: selection factors and survival. Int J Radiat Oncol Biol Phys 36:1045–1053, 1996Google Scholar
  20. 20.
    Galanis E, Buckner J, Novotny P, Dinapoli R, Schomberg P, Morton R, McGinnis W, O'Fallon J: Utility of neuroimaging, neurologic examination and symptom status in follow-up of high-grade glioma patients. Proceedings of ASCO 17:380a, 1998Google Scholar
  21. 21.
    Souhami L, Oliver A, Podgorsak EB, Villemure J, Pla M, Sadikot AF: Fractionated stereotactic radiation therapy. Cancer 68:2101–2108, 1991Google Scholar
  22. 22.
    Lederman G, Arbit E, Odaimi M, Lombardi E, Wrzolek M, Wronski M: Fractionated stereotactic radiosurgery and concurrent Taxol in recurrent glioblastoma multiforme: A preliminary report. Int J Radiat Oncol Biol Phys 40:661–666, 1998Google Scholar

Copyright information

© Plenum Publishing Corporation 1999

Authors and Affiliations

  • Seema Sanghavi
    • 1
  • Ryan Skrupky
    • 1
  • Behnam Badie
    • 2
  • Ian Robins
    • 3
  • Wolfgang Tome
    • 1
  • Minesh P. Mehta
    • 1
  1. 1.Department of Human OncologyUniversity of Wisconsin Hospitals and ClinicsMadison
  2. 2.Department of Neurological SurgeryUniversity of Wisconsin Hospitals and ClinicsMadison
  3. 3.Department of MedicineUniversity of Wisconsin Hospitals and ClinicsMadison

Personalised recommendations