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Radiochirurgie des Glioblastoma multiforme in der Rezidivsituation

The value of radiosurgery for recurrent glioblastoma multiforme. The Heidelberg experience and review of the literature

Heidelberger Erfahrungen im Literaturvergleich

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Zusammenfassung

Ziel

Ergebnisdarstellung einer prospektiven Phase-II-Studie zur stereotaktischen Einzeitbestrahlung von Patienten mit rezidivierendem Glioblastoma multiforme nach primärer Operation und Bestrahlung.

Patienten und Methode

Seit 1986 wurden 62 Patienten mit der Diagnose Glioblastoma multiforme in Maskenfixation radiochirurgisch behandelt. Einschlußkriterien waren Tumor ≤5 cm und Karnofski-Index ≥70. In der Rezidivsituation wurden 27 Patienten behandelt (Durchschnittsalter 50 Jahre). Als Zielvolumen wurde der im zur Bestrahlungsplanung angefertigten Magnetresonanztomogramm (MRT) Kontrastmittel aufnehmende Rezidivtumor mit einem Sicherheitssaum von 2 bis 5 mm definiert. Die mittlere Einzeitdosis betrug 17 Gy, das mediane Intervall von Erstdiagnose und Primärtherapie bis zur Radiochirurgie bei Rezidiv betrug 9,6 Monate. Die Primärtherapie hatte in einer Operation und postoperativen Strahlentherapie (60 Gy) bestanden. Überlebenskurven wurden nach Kaplan Meier berechnet. Die Lebensqualität wurde nach objektiven Kriterien wie neurologischer Befund, Anfallsfrequenz und Cortisonpflichtigkeit bewertet.

Ergebnisse

Das mediane Überleben der Rezidivpatienten betrug 18 Monate nach Diagnosestellung und neun Monate nach Einzeitbestrahlung. Zum Zeitpunkt 4,5 Monate nach Therapie zeigten 50% der behandelten Patienten eine Verbesserung oder Stabilisierung der Lebensqualität.

Schlußfolgerung

In der Rezidivsituation des Glioblastoma multiforme nach primärer Operation und Bestrahlung stellt die Radiochirurgie für ausgewählte Patienten eine Behandlungsoption dar.

Abstract

Aim

To describe the clinical results a prospective phase II study of radiosurgically treated patients with recurrent glioblastoma multiforme.

Patients and Method

Since 1986, 62 patients were irradiated stereotactically. Including criteria were residual tumor ≤5 cm and Karnofsky performance score ≥70. Twenty-seven patients (mean age 50 years) were treated for recurrent tumor. The planning target volume was defined by the contrast enhancing region demonstrated by magnetic resonance imaging (MRI) scans which were performed in treatment position. A safety margin of 2 to 5 mm was added. The mean dose was 17 Gy. The median interval from the time of initial diagnosis and therapy to radiosurgery for recurrent tumor was 9.6 months. Initial therapy consisted of surgery and irradiation (60 Gy). Survival curves were calculated according to the Kaplan Meier method. Quality of life was evaluated using objective criteria such as neurological findings, frequency of seizures and steroid medication.

Results

The median survival calculated from the time of diagnosis was 18 months, calculated from the time of radiosurgery 9 months. 4.5 months after therapy, 50% of the patients showed improved or stable quality of life.

Conclusion

Radiosurgery demonstrates efficacy in selected patients suffering from recurrent glioblastoma multiforme.

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Authors and Affiliations

  1. Klinische Radiologie (Schwerpunkt Strahlentherapie), Radiologische Universitätsklinik, Im Neuenheimer Feld 400, D-69120, Heidelberg

    M. van Kampen, R. Engenhart-Cabillic, J. Debus, M. Fuß & M. Wannenmacher

  2. DKFZ, Heidelberg

    B. Rhein

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  1. M. van Kampen
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  4. M. Fuß
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  5. B. Rhein
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  6. M. Wannenmacher
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van Kampen, M., Engenhart-Cabillic, R., Debus, J. et al. Radiochirurgie des Glioblastoma multiforme in der Rezidivsituation. Strahlenther Onkol 174, 19–24 (1998). https://doi.org/10.1007/BF03038223

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