Fractionated stereotactic radiotherapy using gamma unit after hyperbaric oxygenation on recurrent high-grade gliomas |
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Authors: | Kiyotaka Kohshi Haruaki Yamamoto Ai Nakahara Takahiko Katoh Masashi Takagi |
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Institution: | (1) Division of Hyperbaric Medicine and Department of Neurosurgery, University Hospital of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, 807-8555 Kitakyushu, Japan;(2) Division of Gamma Knife Center, Fukuoka Wajiro Hospital, Fukuoka, Japan;(3) Department of Public Health, School of Medicine, Miyazaki Universiry, Miyazaki, Japan |
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Abstract: | Background To reduce this complication and to enhance the radiation effect to hypoxic cells of high-grade gliomas, the authors performed
noninvasive fractionated stereotactic radiotherapy (FSRT) using a Gamma unit combined with hyperbaric oxygen (HBO) therapy
for the treatment of recurrent disease.
Patients and methods Twenty-five consecutive patients who had previously received radiotherapy with chemotherapy for recurrent high-grade gliomas,
including 14 patients with anaplastic astrocytoma (AA) and 11 with glioblastoma multiforme (GBM), underwent Gamma FSRT immediately
after HBO therapy (2.5 atmospheres absolute for 60 min). The Gamma FSRT was repeatedly performed using a relocatable head
cast. Median tumor volume was 8.7 cc (range, 1.7–159.3 cc), and the median total radiation dose was 22 Gy (range, 18–27 Gy)
to the tumor margin in 8 fractions.
Results Actuarial median survival time after FSRT was 19 months for patients with AA and 11 months for patients with GBM, which was
significantly different (P = 0.012, log-rank test). Two patients underwent subsequent second FSRT for regional or remote recurrence. Seven patients
(28%) underwent subsequent craniotomies and resections at a mean of 8.4 months after FSRT treatment, and 4 of them had radiation
effects without viable cells and remained alive for 50–78 months.
Conclusion Gamma FSRT after HBO therapy appears to confer a survival benefit for patients with recurrent high-grade gliomas and warrants
further investigation. |
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Keywords: | Recurrent gliomas Stereotactic radiotherapy Fractionation Gamma Knife Hyperbaric oxygenation |
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