Salvage reirradiation for recurrent glioblastoma with radiosurgery: radiographic response and improved survival.

9 December 2008

Patel M, Siddiqui F, Jin JY, Mikkelsen T, Rosenblum M, Movsas B, Ryu S.

Henry Ford Health System, Detroit, MI, USA, mpatel2@....

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.

PMID: 19066727 [PubMed - as supplied by publisher]

Commento Personale: Questa tipologia di re-irradiazione alla prima recidiva non ha dimostrato di aumentare significativamente il controllo della malattia (risposte complete, parziali e stabilità) fermandosi al 35/40%, pressochè in modo similare a quanto ottenuto nella raccolta di studi di Wong et al sulla chemioterapia come seconda linea al GBM recidivante. Questa metodologia, da sola, appare comunque in grado di aggiungere 1 o 2 mesi in più di sopravvivenza rispetto all'utilizzo della sola chemioterapia. Inoltre fra coloro che rispondono viene aumentata significativamente la sopravvivneza, addirittura raddioppiandola (da 7 a 15 mesi post recidiva). In questo studio la SRS è risultata migliore della FSRT. Non è una cura, ma l'utilizzo di una re-irradiazione, specialmente tramite una-due dosi (Cyberknife da preferire) è sempre consigliabile a tutti i pazienti. Si faccia riferimento, a riguardo, anche a questo intervento sul forum e al link indicato nell'abstract di questo intervento.

Source J Neurooncol. 2008 Dec 9.