Top

Published in:

Open Access 01-12-2018 | Clinical Study

Gamma knife radiosurgery for recurrent gliomas

Authors: Zjiwar H. A. Sadik, Patrick E. J. Hanssens, Jeroen B. Verheul, Guus N. Beute, Suan Te Lie, Sieger Leenstra, Hilko Ardon

Published in: Journal of Neuro-Oncology | Issue 3/2018

Abstract

Objective

In recent years, gamma knife radiosurgery (GKRS) has become increasingly more popular as a salvage treatment modality for patients diagnosed with recurrent gliomas. The goal of GKRS for recurrent glioma patients is to improve survival rates with minimal burden for these patients. The emphasis of this report is on local tumor control (TC), clinical outcome and survival analysis.

Methods

We performed a retrospective analysis of prospectively collected data of all patients who underwent GKRS for gliomas at the Gamma Knife Center Tilburg between 23-09-2002 and 21-05-2015. In total, 94 patients with glioma were treated with GKRS. Two patients were excluded because GKRS was used as a first stage treatment. The other 92 patients were included for analysis.

Results

TC was 37% for all tumors (TC was 50% in LGGs and 27% in HGGs). Local progression (LP) was 46% for all tumors (LP was 31% in LGGs and 58% in HGGs). New distant lesions were seen in 18% of all patients (in 5% of LGG patients and 31% of HGG patients). Median progression-free and overall survival (PFS and OS) for all patients were 10.5 and 34.4 months, respectively. Median PFS was 50.1 and 5.7 months for low and high grade tumors, respectively. Median OS was 86.6 and 12.8 months for low and high grade tumors, respectively. No serious adverse events were noted post-GKRS.

Conclusion

GKRS can safely be used as salvage treatment for recurrent glioma and seems to improve survival rates in (high grade) glioma patients with minimal burden.

Larjavaara S, Mantyla R, Salminen T, Haapasalo H, Raitanen J, Jaaskelainen J, Auvinen A (2007) Incidence of gliomas by anatomic location. Neuro-Oncology 9:319–325. https://doi.org/10.1215/15228517-2007-016 CrossRefPubMedPubMedCentral

Gousias K, Markou M, Voulgaris S, Goussia A, Voulgari P, Bai M, Polyzoidis K, Kyritsis A, Alamanos Y (2009) Descriptive epidemiology of cerebral gliomas in northwest Greece and study of potential predisposing factors, 2005–2007. Neuroepidemiology 33:89–95. https://doi.org/10.1159/000222090 CrossRefPubMed

Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y, Stroup NE, Kruchko C, Barnholtz-Sloan JS (2013) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2006–2010. Neuro-Oncology 15 (Suppl 2):ii1–ii56 https://doi.org/10.1093/neuonc/not151 CrossRefPubMedPubMedCentral

Crocetti E, Trama A, Stiller C, Caldarella A, Soffietti R, Jaal J, Weber DC, Ricardi U, Slowinski J, Brandes A (2012) Epidemiology of glial and non-glial brain tumours in Europe. Eur J Cancer 48:1532–1542 https://doi.org/10.1016/j.ejca.2011.12.013 CrossRefPubMed

Sant M, Minicozzi P, Lagorio S, Borge Johannesen T, Marcos-Gragera R, Francisci S (2012) Survival of European patients with central nervous system tumors. Int J Cancer 131:173–185. https://doi.org/10.1002/ijc.26335 CrossRefPubMed

Tseng MY, Tseng JH, Merchant E (2006) Comparison of effects of socioeconomic and geographic variations on survival for adults and children with glioma. J Neurosurg 105:297–305. https://doi.org/10.3171/ped.2006.105.4.297 CrossRefPubMed

Jung KW, Yoo H, Kong HJ, Won YJ, Park S, Lee SH (2012) Population-based survival data for brain tumors in Korea. J Neuro-Oncol 109:301–307. https://doi.org/10.1007/s11060-012-0893-5 CrossRef

Lee CH, Jung KW, Yoo H, Park S, Lee SH (2010) Epidemiology of primary brain and central nervous system tumors in Korea. J Korean Neurosurg Soc 48:145–152. https://doi.org/10.3340/jkns.2010.48.2.145 CrossRefPubMedPubMedCentral

Gigineishvili D, Shengelia N, Shalashvili G, Rohrmann S, Tsiskaridze A, Shakarishvili R (2013) Primary brain tumour epidemiology in Georgia: first-year results of a population-based study. J Neuro-Oncology 112:241–246. https://doi.org/10.1007/s11060-013-1054-1 CrossRef

10.

Dubrow R, Darefsky AS (2011) Demographic variation in incidence of adult glioma by subtype, United States, 1992–2007. BMC Cancer 11:325. https://doi.org/10.1186/1471-2407-11-325 CrossRefPubMedPubMedCentral

11.

Cabrera AR, Kirkpatrick JP, Fiveash JB, Shih HA, Koay EJ, Lutz S, Petit J, Chao ST, Brown PD, Vogelbaum M, Reardon DA, Chakravarti A, Wen PY, Chang E (2016) Radiation therapy for glioblastoma: executive summary of an American society for radiation oncology evidence-based clinical practice guideline. Pract Radiat Oncol 6:217–225. https://doi.org/10.1016/j.prro.2016.03.007 CrossRefPubMed

12.

Biswas T, Okunieff P, Schell MC, Smudzin T, Pilcher WH, Bakos RS, Vates GE, Walter KA, Wensel A, Korones DN, Milano MT (2009) Stereotactic radiosurgery for glioblastoma: retrospective analysis. Radiat Oncol 4:11. https://doi.org/10.1186/1748-717x-4-11 CrossRefPubMedPubMedCentral

13.

Lamborn KR, Yung WK, Chang SM, Wen PY, Cloughesy TF, DeAngelis LM, Robins HI, Lieberman FS, Fine HA, Fink KL, Junck L, Abrey L, Gilbert MR, Mehta M, Kuhn JG, Aldape KD, Hibberts J, Peterson PM, Prados MD (2008) Progression-free survival: an important end point in evaluating therapy for recurrent high-grade gliomas. Neuro-Oncology 10:162–170. https://doi.org/10.1215/15228517-2007-062 CrossRefPubMedPubMedCentral

14.

Wong ET, Hess KR, Gleason MJ, Jaeckle KA, Kyritsis AP, Prados MD, Levin VA, Yung WK (1999) Outcomes and prognostic factors in recurrent glioma patients enrolled onto phase II clinical trials. J Clin Oncol 17:2572–2578. https://doi.org/10.1200/jco.1999.17.8.2572 CrossRefPubMed

15.

Gagliardi F, Bailo M, Spina A, Donofrio CA, Boari N, Franzin A, Fava A, Vecchio AD, Bolognesi A, Mortini P (2017) Gamma knife radiosurgery for low-grade gliomas: clinical results at long-term follow-up on tumor control and patients’ quality of life. World Neurosurg. https://doi.org/10.1016/j.wneu.2017.02.041 CrossRefPubMed

16.

Bokstein F, Blumenthal DT, Corn BW, Gez E, Matceyevsky D, Shtraus N, Ram Z, Kanner AA (2016) Stereotactic radiosurgery (SRS) in high-grade glioma: judicious selection of small target volumes improves results. J Neuro-Oncol 126:551–557. https://doi.org/10.1007/s11060-015-1997-5 CrossRef

17.

Skeie BS, Enger PO, Brogger J, Ganz JC, Thorsen F, Heggdal JI, Pedersen PH (2012) Gamma knife surgery versus reoperation for recurrent glioblastoma multiforme. World Neurosurg 78:658–669. https://doi.org/10.1016/j.wneu.2012.03.024 CrossRefPubMed

18.

Elliott RE, Parker EC, Rush SC, Kalhorn SP, Moshel YA, Narayana A, Donahue B, Golfinos JG (2011) Efficacy of gamma knife radiosurgery for small-volume recurrent malignant gliomas after initial radical resection. World Neurosurg 76:128–140. https://doi.org/10.1016/j.wneu.2010.12.053 (discussion 161–122)CrossRefPubMed

19.

Koga T, Maruyama K, Tanaka M, Ino Y, Saito N, Nakagawa K, Shibahara J, Todo T (2012) Extended field stereotactic radiosurgery for recurrent glioblastoma. Cancer 118:4193–4200. https://doi.org/10.1002/cncr.27372 CrossRefPubMed

20.

Kong DS, Lee JI, Park K, Kim JH, Lim DH, Nam DH (2008) Efficacy of stereotactic radiosurgery as a salvage treatment for recurrent malignant gliomas. Cancer 112:2046–2051. https://doi.org/10.1002/cncr.23402 CrossRefPubMed

21.

Hsieh PC, Chandler JP, Bhangoo S, Panagiotopoulos K, Kalapurakal JA, Marymont MH, Cozzens JW, Levy RM, Salehi S (2005) Adjuvant gamma knife stereotactic radiosurgery at the time of tumor progression potentially improves survival for patients with glioblastoma multiforme. Neurosurgery 57:684–692 (discussion 684–692)CrossRefPubMed

22.

Szeifert GT, Prasad D, Kamyrio T, Steiner M, Steiner LE (2007) The role of the gamma knife in the management of cerebral astrocytomas. Prog Neurol Surg 20:150–163. https://doi.org/10.1159/000100102 CrossRefPubMed

23.

Combs SE, Widmer V, Thilmann C, Hof H, Debus J, Schulz-Ertner D (2005) Stereotactic radiosurgery (SRS): treatment option for recurrent glioblastoma multiforme (GBM). Cancer 104:2168–2173. https://doi.org/10.1002/cncr.21429 CrossRefPubMed

24.

Patel M, Siddiqui F, Jin JY, Mikkelsen T, Rosenblum M, Movsas B, Ryu S (2009) Salvage reirradiation for recurrent glioblastoma with radiosurgery: radiographic response and improved survival. J Neuro-Oncol 92:185–191. https://doi.org/10.1007/s11060-008-9752-9 CrossRef

25.

Cho KH, Hall WA, Gerbi BJ, Higgins PD, McGuire WA, Clark HB (1999) Single dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas. Int J Radiat Oncol Biol Phys 45:1133–1141CrossRefPubMed

26.

Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996. https://doi.org/10.1056/NEJMoa043330 CrossRef

Title: Gamma knife radiosurgery for recurrent gliomas
Authors: Zjiwar H. A. Sadik
Patrick E. J. Hanssens
Jeroen B. Verheul
Guus N. Beute
Suan Te Lie
Sieger Leenstra
Hilko Ardon
Publication date: 01-12-2018
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 3/2018
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-018-2988-0

At a glance: The STEP trials

Springer Medicine

Gamma knife radiosurgery for recurrent gliomas

Abstract

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2018

Bevacizumab and re-irradiation for recurrent high grade gliomas: does sequence matter?

Mebendazole and radiation in combination increase survival through anticancer mechanisms in an intracranial rodent model of malignant meningioma

Platelet count is associated with outcome in cancer patients with stroke

A comparative analysis of clinicopathological features and survival among early adolescents/young adults and children with low-grade glioma: a report from the Children’s Oncology Group

Acknowledgement of reviewers 2016 and 2017

Defining a prognostic score based on O6-methylguanine-DNA methyltransferase cut-off methylation level determined by pyrosequencing in patients with glioblastoma multiforme