Salvage reirradiation for recurrent glioblastoma with radiosurgery: radiographic response and improved survival |
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Authors: | Mehul Patel Farzan Siddiqui Jian-Yue Jin Tom Mikkelsen Mark Rosenblum Benjamin Movsas and Samuel Ryu |
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Institution: | (1) Henry Ford Health System, Detroit, MI, USA |
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Abstract: | Purpose To determine the radiographic and clinical efficacy of stereotactic single dose radiosurgery (SRS) and fractionated stereotactic
radiotherapy (FSRT) as salvage therapy for glioblastoma (GBM) at recurrence. Methods Thirty-six patients with pathologically proven recurrent GBM were treated with salvage reirradiation by either SRS or FSRT
between March of 2001 and August of 2006. Thirty-one patients had an initial diagnosis of GBM. Five patients had a malignant
transformation. All patients had received radiotherapy with a dose of 50–60 Gy, a median 13.6 months prior to reirradiation
(range: 0.8–119 months). At the time of recurrence, 26 patients were treated with SRS with a median dose of 18 Gy (range:
12–20 Gy). FSRT was performed in ten patients with a dose of 36 Gy in six fractions, twice weekly. Follow-up included MRI
and clinical examination every 2 months. Results Median survival time after SRS was 8.5 months, compared to 7.4 months after FSRT (P = 0.81). Of 26 patients treated with SRS, radiographic tumor response or stable disease was observed in eight (35%) patients
and tumor progression was seen in 18 (65%) patients. Of 10 patients treated by FSRT, radiographic tumor response or stable
disease was observed in four (40%) patients and tumor progression was observed in four (40%) patients (two lost to follow-up).
Patients who responded to treatment had statistically improved survival compared to non-responders, with median survival of
15.8 vs. 7.3 months (P < 0.05). Conclusion Salvage reirradiation with SRS or FSRT for recurrent GBM results in radiographic response in a proportion of patients. Survival
was significantly improved among patients who either responded or had stable disease after salvage reirradiation, compared
to non-responders. Further study is warranted to investigate the method and time of reirradiation for recurrent GBM. |
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Keywords: | Glioblastoma Recurrence Radiotherapy Reirradiation Radiosurgery |
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