Preservation of quality of life by preradiotherapy stereotactic radiosurgery for unresectable glioblastoma multiforme.

21 December 2006

Kong DS, Nam DH, Lee JI, Park K, Kim JH.

Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea.

OBJECT: The authors conducted a retrospective study to evaluate the efficacy of Gamma Knife surgery (GKS) followed by radiotherapy for the treatment of unresectable glioblastomas multiforme (GBMs) on patient survival and quality of life. METHODS: A total of 19 patients with unresectable GBMs located in eloquent areas of the brain were eligible for this study. Beginning in January 2002, 10 patients underwent GKS followed by fractionated radiotherapy. Nine patients who had undergone radiotherapy alone after biopsy-proven diagnosis served as the control group. The mean patient ages were 53 years and 56 years, respectively. Preoperative Karnofsky Performance Scale (KPS) scores were 80 (range 60-100) and 90 (range 50-100), respectively. The median margin dose for GKS was 12 Gy (9-16 Gy), and the total dose for radiotherapy was 60 Gy in 30 fractions. The mean follow-up duration was 7.2 months, the median patient survival time was 52 weeks (95% confidence interval [CI] 22-110.6 weeks) in the GKS group, and the median overall survival time was 28 weeks (95% CI 22.5-33.5 weeks) in the control group. The difference was not statistically significant (p = 0.0758). The estimated progression-free survival rate at 3 months was 75% in the GKS group and 45% in the control group (p = 0.082). The posttreatment KPS scores were either unchanged or improved in the GKS group, whereas it deteriorated by 20 or more points in six of nine patients of the control group (p = 0.004). CONCLUSIONS: Gamma Knife surgery prior to radiotherapy may be helpful in preserving patients' daily activities in the adjuvant management of unresectable GBM.

PMID: 18503347 [PubMed - in process]

Commento Personale: L’utilizzo di radiochirurgia stereotassica con Gamma Knife in pazienti non operabili seguita da radioterapia esterna tradizionale aiuta ad aumentare la sopravvivenza. Il gruppo di pazienti infatti trattati con entrambe le tecniche ha mantenuto una sopravvivenza mediana di 52 settimane contro 28 settimane nei pazienti trattati con sola radioterapia. Sebbene la sopravvivenza venga aumentata nei pazienti non operabili attraverso questa combinazione di radioterapie, essa rimane sempre decisamente bassa.

Source J Neurosurg. 2006 Dec