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Stereotactic radiosurgery for IDH wild type glioblastoma: an international, multicenter study

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Abstract

Objective

Isocitrate dehydrogenase (IDH) mutation status is recommended used for diagnosis and prognostication of glioblastoma patients. We studied efficacy and safety of stereotactic radiosurgery (SRS) for patients with recurrent IDH-wt glioblastoma.

Methods

Consecutive patients treated with SRS for IDH-wt glioblastoma were pooled for this retrospective observational international multi-institutional study from institutions participating in the International Radiosurgery Research Foundation.

Results

Sixty patients (median age 61 years) underwent SRS (median dose 15 Gy and median treatment volume: 7.01 cm3) for IDH-wt glioblastoma. All patients had histories of surgery and chemotherapy with temozolomide, and 98% underwent fractionated radiation therapy. MGMT status was available for 42 patients, of which half of patients had MGMT mutant glioblastomas. During median post-SRS imaging follow-up of 6 months, 52% of patients experienced tumor progression. Median post-SRS progression free survival was 4 months. SRS prescription dose of > 14 Gy predicted longer progression free survival [HR 0.357 95% (0.164–0.777) p = 0.009]. Fifty-percent of patients died during post-SRS clinical follow-up that ranged from 1 to 33 months. SRS treatment volume of > 5 cc emerged as an independent predictor of shorter post-SRS overall survival [HR 2.802 95% CI (1.219–6.444) p = 0.02]. Adverse radiation events (ARE) suggestive of radiation necrosis were diagnosed in 6/55 (10%) patients and were managed conservatively in the majority of patients.

Conclusions

SRS prescription dose of > 14 Gy is associated with longer progression free survival while tumor volume of > 5 cc is associated with shorter overall survival after SRS for IDH-wt glioblastomas. AREs are rare and are typically managed conservatively.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA

    Adomas Bunevicius, Stylianos Pikis & Jason Sheehan

  2. Department of Neurosurgery, NYU Langone Health, New York, USA

    Douglas Kondziolka & Dev N. Patel

  3. Department of Radiation Oncology, NYU Langone Health, New York, USA

    Kenneth Bernstein & Erik P. Sulman

  4. Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan

    Cheng-chia Lee

  5. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Cheng-chia Lee & Huai-che Yang

  6. Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada

    Violaine Delabar & David Mathieu

  7. Department of Neurosurgery, West Virginia University, Morgantown, WV, USA

    Christopher P. Cifarelli & David E. Arsanious

  8. Department of Radiation Oncology, West Virginia University, Morgantown, WV, USA

    Basem A. Dahshan & Joshua S. Weir

  9. Gamma Knife, Radiology Department, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic

    Herwin Speckter & Angel Mota

  10. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Manjul Tripathi

  11. Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Narendra Kumar

  12. Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, OH, USA

    Ronald E. Warnick

  13. Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey

    Selcuk Peker & Yavuz Samanci

  14. Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA

    Gene Barnett, Farid El Hefnawi & Ghusn Al Sideiri

  15. Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, 22908, USA

    Jason Sheehan

Authors
  1. Adomas Bunevicius
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  2. Stylianos Pikis
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Contributions

Study design: AB and JS. Material preparation and data collection: all authors. Statistical analysis: AB. The first draft of the manuscript was written by AB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jason Sheehan.

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Conflict of interest

Author Dr. REW is a member of the Novalis Circle Expert Board. Other authors report no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was waived given the study design.

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Bunevicius, A., Pikis, S., Kondziolka, D. et al. Stereotactic radiosurgery for IDH wild type glioblastoma: an international, multicenter study. J Neurooncol 155, 343–351 (2021). https://doi.org/10.1007/s11060-021-03883-8

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