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Factors predictive of improved overall survival following stereotactic radiosurgery for recurrent glioblastoma

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Abstract

The currently accepted standard of care for primary glioblastoma (GBM) consists of maximal surgical resection followed by fractionated external beam radiotherapy (EBRT) with concomitant temozolomide chemotherapy. The role of stereotactic radiosurgery (SRS) in the treatment of GBM is not well defined, but SRS has typically been applied as a salvage therapy for GBM recurrence. This paper reviews our single institution experience using gamma knife radiosurgery (GKRS) for the treatment of GBM. Thirty-six patients treated with GKRS for pathologically proven GBM at LSU Health in Shreveport from February 2000 to December 2013 were identified and analyzed. Patient characteristics, treatment variables, and survival were correlated. Seven patients received GKRS in the immediate postoperative period for an average tumor volume of 10.9 cm3, and 29 patients were treated for a recurrent average tumor volume of 11.4 cm3 with a prescribed dose ranging from 10 to 20 Gy at the 50 % isodose line. The median overall survival was significantly higher in recurrence group compared to up-front group [7.9 months (0.77–32.1 months) vs. 3.5 months (range 0.23–11.7 months) respectively, (p = 0.018)]. The predictive factors for improved survival in the patients with GBM were as follows: Karnofsky performance scale (KPS) > 70 (p = 0.026), age ≤ 50 years (p = 0.006), absence of neurodeficits (p = 0.01), and initial postoperative treatment with EBRT (p = 0.042). Adjuvant therapy with GKRS following GBM recurrence demonstrates statistical superiority over immediate postoperative boost therapy.

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Authors and Affiliations

  1. Department of Neurosurgery, LSU Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130-3932, USA

    Shyamal C. Bir, David E. Connor Jr., Sudheer Ambekar, Jessica A. Wilden & Anil Nanda

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  1. Shyamal C. Bir
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  2. David E. Connor Jr.
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  3. Sudheer Ambekar
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  4. Jessica A. Wilden
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  5. Anil Nanda
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Correspondence to Anil Nanda.

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Comments

Andrea Arcos, Malaga, Spain

The management of glioblastoma (GBM) is complex and the advances in surgical approaches, radiotherapy, and chemotherapy are contributing to incremental improvements in survival in these patients. Stereotactic radiosurgery (SRS) has emerged as a possible adjunct therapy to the standard therapy for GBM, nevertheless the survival benefit of gamma knife radio surgery (GKRS) for GBM is not clear. In fact, following a PubMed search of this item from 2005 to the present, I could find ten articles and only a few more about SRS in the treatment of GBM.

The present paper reviews the experience of a single center using GKRS for the treatment of GBM in 36 patients from 2000 to 2013. The median overall survival was 18.2 months from diagnosis, and 7.25 from recurrence. The overall survival was significantly higher in recurrence group compared to up-front group (7.9 vs 3.5 months). The predictive factors for improved survival were Karnofsky performance >70 (p = 0.026), age ≤50 years (p = 0.006), absence of neurodeficits (p = 0.01), and initial postoperative treatment with fractionated external beam radiotherapy (EBRT) (p = 0.042).

This study adds new and interesting information about the applications of GKRS in the treatment of GBM, and it also gives us a clear clinical message about the predictive factors for improved survival in these patients.

Although authors know the limitations of the study, particularly the retrospective nature of this research and variability on the treatments, we add on, the relatively small number of patients. On the other hand, given the low therapeutic performance of the standard treatment of GBM, this research is more than has been achieved before, and it gives us a perspective to further investigations and preliminary clues for counseling of patients.

The authors present in this issue aims to clarify the treatment variability and to elucidate prognostic factors that could lead the increase in the survival of these patients. Therefore, it covers an interesting and timely investigation that is correctly performed.

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Bir, S.C., Connor, D.E., Ambekar, S. et al. Factors predictive of improved overall survival following stereotactic radiosurgery for recurrent glioblastoma. Neurosurg Rev 38, 705–713 (2015). https://doi.org/10.1007/s10143-015-0632-4

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  • DOI: https://doi.org/10.1007/s10143-015-0632-4

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