Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2009

Open Access 01-12-2009 | Research

Stereotactic radiosurgery for glioblastoma: retrospective analysis

Authors: Tithi Biswas, Paul Okunieff, Michael C Schell, Therese Smudzin, Webster H Pilcher, Robert S Bakos, G Edward Vates, Kevin A Walter, Andrew Wensel, David N Korones, Michael T Milano

Published in: Radiation Oncology | Issue 1/2009

Login to get access

Abstract

Purpose

This retrospective study was done to better understand the conditions for which stereotactic radiosurgery (SRS) for glioblastoma may be efficacious.

Methods

Between 2000 and 2007, 33 patients with a pathological diagnosis of glioblastoma received SRS with the Novalis® Shaped Beam Radiosurgery system. Eighteen patients (54%) underwent salvage SRS for recurrence while 15 (45%) patients received upfront SRS following standard fractionated RT for newly diagnosed glioblastoma.

Results

There were no RTOG grade >2 acute side effects. The median survival after SRS was 6.7 months (range 1.4 – 74.7). There was no significant difference in overall survival (from the time of initial diagnosis) with respect to the timing of SRS (p = 0.2). There was significantly better progression free survival in patients treated with SRS as consolidation versus at the time of recurrence (p = 0.04). The majority of patients failed within or at the margin of the SRS treatment volume (21/26 evaluable for recurrence).

Conclusion

SRS is well tolerated in the treatment of glioblastoma. As there was no difference in survival whether SRS is delivered upfront or at recurrence, the treatment for each patient should be individualized. Future studies are needed to identify patients most likely to respond to SRS.
Appendix
Available only for authorised users
Literature
1.
Buatti J, Ryken TC, Smith MC, Sneed P, Suh JH, Mehta M, Olson JJ: Radiation therapy of pathologically confirmed newly diagnosed glioblastoma in adults. J Neurooncol 2008, 89: 313-337. 10.1007/s11060-008-9617-2CrossRefPubMed
2.
Stupp R, Mason WP, Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, et al.: Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005, 352: 987-996. 10.1056/NEJMoa043330CrossRefPubMed
3.
Mirimanoff RO, Gorlia T, Mason W, Bent MJ, Kortmann RD, Fisher B, Reni M, Brandes AA, Curschmann J, Villa S, et al.: Radiotherapy and temozolomide for newly diagnosed glioblastoma: recursive partitioning analysis of the EORTC 26981/22981-NCIC CE3 phase III randomized trial. J Clin Oncol 2006, 24: 2563-2569. 10.1200/JCO.2005.04.5963CrossRefPubMed
4.
Gorlia T, Bent MJ, Hegi ME, Mirimanoff RO, Weller M, Cairncross JG, Eisenhauer E, Belanger K, Brandes AA, Allgeier A, et al.: Nomograms for predicting survival of patients with newly diagnosed glioblastoma: prognostic factor analysis of EORTC and NCIC trial 26981-22981/CE.3. Lancet Oncol 2008, 9: 29-38. 10.1016/S1470-2045(07)70384-4CrossRefPubMed
5.
Walker MD, Strike TA, Sheline GE: An analysis of dose-effect relationship in the radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys 1979, 5: 1725-1731.CrossRefPubMed
6.
Bleehen NM, Stenning SP: A Medical Research Council trial of two radiotherapy doses in the treatment of grades 3 and 4 astrocytoma. The Medical Research Council Brain Tumour Working Party. Br J Cancer 1991, 64: 769-774.PubMedCentralCrossRefPubMed
7.
Deutsch M, Green SB, Strike TA, Burger PC, Robertson JT, Selker RG, Shapiro WR, Mealey J Jr, Ransohoff J 2nd, Paoletti P, et al.: Results of a randomized trial comparing BCNU plus radiotherapy, streptozotocin plus radiotherapy, BCNU plus hyperfractionated radiotherapy, and BCNU following misonidazole plus radiotherapy in the postoperative treatment of malignant glioma. Int J Radiat Oncol Biol Phys 1989, 16: 1389-1396.CrossRefPubMed
8.
Nelson DF, Curran WJ Jr, Scott C, Nelson JS, Weinstein AS, Ahmad K, Constine LS, Murray K, Powlis WD, Mohiuddin M, et al.: Hyperfractionated radiation therapy and bis-chlorethyl nitrosourea in the treatment of malignant glioma – possible advantage observed at 72.0 Gy in 1.2 Gy B.I.D. fractions: report of the Radiation Therapy Oncology Group Protocol 8302. Int J Radiat Oncol Biol Phys 1993, 25: 193-207.CrossRefPubMed
9.
Coughlin C, Scott C, Langer C, Coia L, Curran W, Rubin P: Phase II, two-arm RTOG trial (94-11) of bischloroethyl-nitrosourea plus accelerated hyperfractionated radiotherapy (64.0 or 70.4 Gy) based on tumor volume (> 20 or < or = 20 cm(2), respectively) in the treatment of newly-diagnosed radiosurgery-ineligible glioblastoma multiforme patients. Int J Radiat Oncol Biol Phys 2000, 48: 1351-1358.CrossRefPubMed
10.
Werner-Wasik M, Scott CB, Nelson DF, Gaspar LE, Murray KJ, Fischbach JA, Nelson JS, Weinstein AS, Curran WJ Jr: Final report of a phase I/II trial of hyperfractionated and accelerated hyperfractionated radiation therapy with carmustine for adults with supratentorial malignant gliomas. Radiation Therapy Oncology Group Study 83-02. Cancer 1996, 77: 1535-1543. Publisher Full Text10.1002/(SICI)1097-0142(19960415)77:8%3C1535::AID-CNCR17%3E3.0.CO;2-0CrossRefPubMed
11.
Prados MD, Wara WM, Sneed PK, McDermott M, Chang SM, Rabbitt J, Page M, Malec M, Davis RL, Gutin PH, et al.: Phase III trial of accelerated hyperfractionation with or without difluromethylornithine (DFMO) versus standard fractionated radiotherapy with or without DFMO for newly diagnosed patients with glioblastoma multiforme. Int J Radiat Oncol Biol Phys 2001, 49: 71-77.CrossRefPubMed
12.
Cardinale R, Won M, Choucair A, Gillin M, Chakravarti A, Schultz C, Souhami L, Chen A, Pham H, Mehta M: A phase II trial of accelerated radiotherapy using weekly stereotactic conformal boost for supratentorial glioblastoma multiforme: RTOG 0023. Int J Radiat Oncol Biol Phys 2006, 65: 1422-1428.CrossRefPubMed
13.
Lee SW, Fraass BA, Marsh LH, Herbort K, Gebarski SS, Martel MK, Radany EH, Lichter AS, Sandler HM: Patterns of failure following high-dose 3-D conformal radiotherapy for high-grade astrocytomas: a quantitative dosimetric study. Int J Radiat Oncol Biol Phys 1999, 43: 79-88.CrossRefPubMed
14.
Nelson DF, Diener-West M, Horton J, Chang CH, Schoenfeld D, Nelson JS: Combined modality approach to treatment of malignant gliomas – re-evaluation of RTOG 7401/ECOG 1374 with long-term follow-up: a joint study of the Radiation Therapy Oncology Group and the Eastern Cooperative Oncology Group. NCI Monogr 1988, 279-284.
15.
Salazar OM, Rubin P, Feldstein ML, Pizzutiello R: High dose radiation therapy in the treatment of malignant gliomas: final report. Int J Radiat Oncol Biol Phys 1979, 5: 1733-1740.CrossRefPubMed
16.
Souhami L, Seiferheld W, Brachman D, Podgorsak EB, Werner-Wasik M, Lustig R, Schultz CJ, Sause W, Okunieff P, Buckner J, et al.: Randomized comparison of stereotactic radiosurgery followed by conventional radiotherapy with carmustine to conventional radiotherapy with carmustine for patients with glioblastoma multiforme: report of Radiation Therapy Oncology Group 93-05 protocol. Int J Radiat Oncol Biol Phys 2004, 60: 853-860.CrossRefPubMed
17.
Wallner KE, Galicich JH, Krol G, Arbit E, Malkin MG: Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 1989, 16: 1405-1409.CrossRefPubMed
18.
Liang BC, Thornton AF Jr, Sandler HM, Greenberg HS: Malignant astrocytomas: focal tumor recurrence after focal external beam radiation therapy. J Neurosurg 1991, 75: 559-563.CrossRefPubMed
19.
Hess CF, Schaaf JC, Kortmann RD, Schabet M, Bamberg M: Malignant glioma: patterns of failure following individually tailored limited volume irradiation. Radiother Oncol 1994, 30: 146-149. 10.1016/0167-8140(94)90044-2CrossRefPubMed
20.
Sneed PK, Gutin PH, Larson DA, Malec MK, Phillips TL, Prados MD, Scharfen CO, Weaver KA, Wara WM: Patterns of recurrence of glioblastoma multiforme after external irradiation followed by implant boost. Int J Radiat Oncol Biol Phys 1994, 29: 719-727.CrossRefPubMed
21.
Mayer R, Sminia P: Reirradiation tolerance of the human brain. Int J Radiat Oncol Biol Phys 2008, 70: 1350-1360.CrossRefPubMed
22.
Shrieve DC, Alexander E 3rd, Wen PY, Fine HA, Kooy HM, Black PM, Loeffler JS: Comparison of stereotactic radiosurgery and brachytherapy in the treatment of recurrent glioblastoma multiforme. Neurosurgery 1995, 36: 275-282. 10.1097/00006123-199502000-00006CrossRefPubMed
23.
Kondziolka D, Flickinger JC, Bissonette DJ, Bozik M, Lunsford LD: Survival benefit of stereotactic radiosurgery for patients with malignant glial neoplasms. Neurosurgery 1997, 41: 776-783. 10.1097/00006123-199710000-00004CrossRefPubMed
24.
Cho KH, Hall WA, Gerbi BJ, Higgins PD, McGuire WA, Clark HB: Single dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas. Int J Radiat Oncol Biol Phys 1999, 45: 1133-1141. 10.1016/S0360-3016(99)00336-3CrossRefPubMed
25.
Sanghavi S, Skrupy R, Badic B, Robins I, Tome W, Mehta M: Recurrent Malignant Gliomas Treated with Radiosurgery. J Radiosurg 1999, 2: 119-125. 10.1023/A:1022969211720CrossRef
26.
Park JL, Suh JH, Barnett GH, Reddy CA, Peereboom DM, Stevens GHJ, Cohen BH: Survival after Stereotactic Radiosurgery for Recurrent Glioblastoma Multiforme. J Radiosurg 2000, 3: 169-175. 10.1023/A:1009542525044CrossRef
27.
Larson DA, Prados M, Lamborn KR, Smith V, Sneed PK, Chang S, Nicholas KM, Wara WM, Devriendt D, Kunwar S, et al.: Phase II study of high central dose Gamma Knife radiosurgery and marimastat in patients with recurrent malignant glioma. Int J Radiat Oncol Biol Phys 2002, 54: 1397-1404.CrossRefPubMed
28.
Combs SE, Widmer V, Thilmann C, Hof H, Debus J, Schulz-Ertner D: Stereotactic radiosurgery (SRS): treatment option for recurrent glioblastoma multiforme (GBM). Cancer 2005, 104: 2168-2173. 10.1002/cncr.21429CrossRefPubMed
29.
Mahajan A, McCutcheon IE, Suki D, Chang EL, Hassenbusch SJ, Weinberg JS, Shiu A, Maor MH, Woo SY: Case-control study of stereotactic radiosurgery for recurrent glioblastoma multiforme. J Neurosurg 2005, 103: 210-217.CrossRefPubMed
30.
Patel MK, Siddiqui F, Scarpace L, Jin J, Mikkelsen T, Movsas B, Ryu S: Salvage Radiosurgery of Recurrent Glioblastoma Multiforme: Radiographic Tumor Control and Clinical Outcome. ASTRO; Los Angeles; 2007.
31.
Korones D, Okunieff P, Milano M: Accelerated radiotherapy and temozolomide in adults with newly diagnosed glioblastoma multiforme – a pilot study. J Clin Oncol 2008., 26:
32.
Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, Farnan N: Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys 2000, 47: 291-298. 10.1016/S0360-3016(99)00507-6CrossRefPubMed
33.
Nwokedi EC, DiBiase SJ, Jabbour S, Herman J, Amin P, Chin LS: Gamma knife stereotactic radiosurgery for patients with glioblastoma multiforme. Neurosurgery 2002, 50: 41-46. 10.1097/00006123-200201000-00009PubMed
34.
Sarkaria JN, Mehta MP, Loeffler JS, Buatti JM, Chappell RJ, Levin AB, Alexander E 3rd, Friedman WA, Kinsella TJ: Radiosurgery in the initial management of malignant gliomas: survival comparison with the RTOG recursive partitioning analysis. Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 1995, 32: 931-941. 10.1016/0360-3016(95)97828-OCrossRefPubMed
35.
Lustig RA, Scott CB, Curran WJ: Does stereotactic eligibility for the treatment of glioblastoma cause selection bias in randomized studies? Am J Clin Oncol 2004, 27: 516-521. 10.1097/01.coc.0000135641.82026.c4CrossRefPubMed
36.
Tsao MN, Mehta MP, Whelan TJ, Morris DE, Hayman JA, Flickinger JC, Mills M, Rogers CL, Souhami L: The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for malignant glioma. Int J Radiat Oncol Biol Phys 2005, 63: 47-55.CrossRefPubMed
37.
Nieder C, Grosu AL, Molls M: A comparison of treatment results for recurrent malignant gliomas. Cancer Treat Rev 2000, 26: 397-409. 10.1053/ctrv.2000.0191CrossRefPubMed
38.
Nieder C, Wiedenmann N, Andratschke N, Molls M: Current status of angiogenesis inhibitors combined with radiation therapy. Cancer Treat Rev 2006, 32: 348-364. 10.1016/j.ctrv.2006.03.006CrossRefPubMed
39.
Hau P, Baumgart U, Pfeifer K, Bock A, Jauch T, Dietrich J, Fabel K, Grauer O, Wismeth C, Klinkhammer-Schalke M, et al.: Salvage therapy in patients with glioblastoma: is there any benefit? Cancer 2003, 98: 2678-2686. 10.1002/cncr.11845CrossRefPubMed
40.
Grosu AL, Weber WA, Franz M, Stark S, Piert M, Thamm R, Gumprecht H, Schwaiger M, Molls M, Nieder C: Reirradiation of recurrent high-grade gliomas using amino acid PET (SPECT)/CT/MRI image fusion to determine gross tumor volume for stereotactic fractionated radiotherapy. Int J Radiat Oncol Biol Phys 2005, 63: 511-519.CrossRefPubMed
41.
Chakravarti A, Seiferheld W, Tu X, Wang H, Zhang HZ, Ang KK, Hammond E, Curran W Jr, Mehta M: Immunohistochemically determined total epidermal growth factor receptor levels not of prognostic value in newly diagnosed glioblastoma multiforme: report from the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 2005, 62: 318-327.CrossRefPubMed
42.
Krex D, Klink B, Hartmann C, von Deimling A, Pietsch T, Simon M, Sabel M, Steinbach JP, Heese O, Reifenberger G, et al.: Long-term survival with glioblastoma multiforme. Brain 2007, 130: 2596-2606. 10.1093/brain/awm204CrossRefPubMed
43.
Hegi ME, Diserens AC, Gorlia T, Hamou MF, de Tribolet N, Weller M, Kros JM, Hainfellner JA, Mason W, Mariani L, et al.: MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 2005, 352: 997-1003. 10.1056/NEJMoa043331CrossRefPubMed
Metadata
Title
Stereotactic radiosurgery for glioblastoma: retrospective analysis
Authors
Tithi Biswas
Paul Okunieff
Michael C Schell
Therese Smudzin
Webster H Pilcher
Robert S Bakos
G Edward Vates
Kevin A Walter
Andrew Wensel
David N Korones
Michael T Milano
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2009
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-4-11

Other articles of this Issue 1/2009

Radiation Oncology 1/2009 Go to the issue

Research

Image guided dose escalated prostate radiotherapy: still room to improve

Research

Systematisation of spatial uncertainties for comparison between a MR and a CT-based radiotherapy workflow for prostate treatments

Research

Remarks on reporting and recording consistent with the ICRU Reference Dose

Research

Late treatment with imatinib mesylate ameliorates radiation-induced lung fibrosis in a mouse model

Research

Clinical-dosimetric analysis of measures of dysphagia including gastrostomy-tube dependence among head and neck cancer patients treated definitively by intensity-modulated radiotherapy with concurrent chemotherapy

Short report

Job stress and job satisfaction of physicians, radiographers, nurses and physicists working in radiotherapy: a multicenter analysis by the DEGRO Quality of Life Work Group