Al's Comment:
This is a small study from Turkey which shows that stereotactic radiosurgery is safe and well tolerated and may improve the progression free survival time as well as overall survival. It is not randomized and is small so it needs to be validated but this is another piece of evidence showing that we should consider stereotactic radiosurgery at the time of recurrence. Stereotactic radiosurgery is a form of radiation therapy that is focused on a target. It can be used even after the maximum dose of standard radiation. There are a few tools that can be used to do it. The one mentioned in the article is Cyberknife but this should apply to all of the tools that can perform fractionated stereotactic radiosurgery
Posted on: 04/06/2020
Stereotact Funct Neurosurg. 2020 Apr 3:1-9. doi: 10.1159/000505706. [Epub ahead of print]
Stereotactic Radiotherapy in Recurrent Glioblastoma: A Valid Salvage Treatment Option.
Yaprak G1, Isik N2, Gemici C2, Pekyurek M2, Ceylaner Bicakci B2, Demircioglu F2, Tatarli N3.
Author information:
1. Department of Radiation Oncology, University of Health Sciences, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey, gokhanyaprak@gmail.com.
2. Department of Radiation Oncology, University of Health Sciences, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
3. Department of Neurosurgery, University of Health Sciences, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
Abstract
BACKGROUND:
Glioblastoma (GBM) is a dismal disease. Recurrence is inevitable despite initial surgery and postoperative temozolomide (TMZ) and radiotherapy. Salvage surgery is the standard treatment in selected patients. Chemotherapy, biological agents, and re-irradiation are other treatment approaches available. Stereotactic radiotherapy (SRT) is nowadays a common treatment as a salvage treatment option.
MATERIALS AND METHODS:
We reviewed the files of 132 GBM cases treated between 2010 and 2018. All patients received TMZ and radiotherapy after surgery or biopsy. Among the patients who had recurrence, we identified 42 cases treated with salvage SRT. The CyberKnife robotic system was used to administer SRT.
RESULTS:
While the median follow-up time for all patients was 16 months (range 1-123), the median follow-up time for patients treated with SRT after initial diagnosis was 26.5 months (range 9-123). The median follow-up time after SRT was 10 months (range 2-107). SRT was performed in a median of 3 fractions (range 2-5). The median prescription dose was 20 Gy (range 18-30). While the median actuarial survival after initial diagnosis for patients treated with salvage SRT was 30 months (range 9-123), it was only 14 months (range 1-111) for patients who could not be treated with salvage SRT (p = 0.001). The median survival time after SRT was 12 months, and 1- and 2-year survival rates were 48 and 9%, respectively. The time to progression after SRT was 5 months (range 1-62), and 6-month and 1-year progression-free survival rates were 50 and 22%, respectively. Patients with longer time to recurrence >12 months had longer overall survival with respect to the ones having recurrence <12 months (p < 0.001). Salvage surgery had been performed in 7 out of 42 patients before SRT. These reoperated patients had significantly worse survival after SRT when compared to the patients who underwent SRT alone (p = 0.02). SRT was well tolerated and there was no grade III/IV toxicity.
CONCLUSIONS:
SRT is a viable salvage treatment option for recurrent GBM. SRT provides acceptable local control and survival benefit for recurrent GBM cases. SRT can be considered especially in patients with long time to recurrence.
© 2020 S. Karger AG, Basel.
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