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Efficacy and toxicity of CyberKnife re-irradiation and “dose dense” temozolomide for recurrent gliomas

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Abstract

Background

Stereotactic radiosurgery (SRS) can be a useful adjunct to the treatment of recurrent glioblastoma multiforme (GBM). Its combination with chemotherapy is attractive for the possible radiosensitization effect and cytotoxicity on tumor cells in distant areas. The aim of this study was to evaluate the efficacy and toxicity of CyberKnife SRS alone and combined with a “dose-dense” administration of temozolomide (TMZ) for recurrent GBM.

Methods

Between July 2007 and July 2010, 23 patients underwent CyberKnife SRS. In 12 patients irradiation was combined with TMZ at 75 mg/m2/day for 21 days every 28 days. The median prescription dose in this group was 20 Gy (mean 20.7 ± 4 Gy) with a median number of fractions of 2. The median dose for the 11 patients who underwent SRS alone was 20 Gy (mean 19.9 ± 4.4 Gy; p = NS).

Results

The median survival was 12 months for patients who underwent SRS/TMZ and 7 months for those who received SRS alone (p < 0.01). The 6-month progression-free survival (PFS) of the SRS/TMZ group was 66.7% vs. 18% for those who underwent SRS alone (p = 0.03). The median time to progression (TTP) was 7 months for patients who underwent SRS/TMZ and 4 months for those who underwent SRS alone (p = 0.01). Corticosteroid dependency was developed by most patients; radionecrosis was evident in one patient (4.3%) receiving TMZ. Grade 3 hematological toxicity was recorded in >40% of patients receiving chemotherapy.

Conclusions

The results suggest that Cyberknife re-treatments are relatively safe using selected dose/fraction schemes. The combination with TMZ improved patients' outcomes with OS and 6-month PFS that favorably compares with alternative treatments, but the incidence of major adverse effects was >40%. Further studies are warranted.

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Abbreviations

EBRT:

external beam radiotherapy

fSRT:

fractionated stereotactic radiotherapy

GBM:

glioblastoma multiforme

GTV:

gross tumor volume

KPS:

Karnofsky performance status

NTD:

normalized total dose

OS:

overall survival

PFS:

progression-free survival

PTV:

planned treatment volume

RPA:

recursive partitioning analysis

SRS:

stereotactic radiosurgery

TMZ:

Temozolomide

TTP:

time to progression

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Acknowledgements

Authors are particularly grateful to Dr. Dave Schaal for the scientific and editorial assistance.

The authors have no potential conflicts of interest arising from associations with commercial or corporate interest in connection with the work submitted to disclose.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Messina, Messina, Italy

    Alfredo Conti, Salvatore Cardali & Francesco Tomasello

  2. Department of Radiation Oncology, University of Messina, Messina, Italy

    Antonio Pontoriero, Donatella Arpa & Costantino De Renzis

  3. Department of Medical Physics, University of Messina, Messina, Italy

    Carmelo Siragusa

  4. Departmen of Oncology, University of Messina, Messina, Italy

    Chiara Tomasello

  5. Department of Neurosurgery, IRCCS Neuromed, Pozzilli (IS), Italy

    Pantaleo Romanelli

  6. Department of Neuroradiology, University of Messina, Messina, Italy

    Francesca Granata

  7. Neurosurgery, Department of Neuroscience, A.O.U. Policlinico Universitario, University of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy

    Alfredo Conti

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  1. Alfredo Conti
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Correspondence to Alfredo Conti.

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Conti, A., Pontoriero, A., Arpa, D. et al. Efficacy and toxicity of CyberKnife re-irradiation and “dose dense” temozolomide for recurrent gliomas. Acta Neurochir 154, 203–209 (2012). https://doi.org/10.1007/s00701-011-1184-1

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  • DOI: https://doi.org/10.1007/s00701-011-1184-1

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