Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Clinical Study

Gamma Knife Radiosurgery in Recurrent Glioblastoma

Frischer J.M.a · Marosi C.b · Woehrer A.e · Hainfellner J.A.e · Dieckmann K.U.d · Eiter H.f · Wang W.-T.a · Mallouhi A.c · Ertl A.a · Knosp E.a · Filipits M.b · Kitz K.a · Gatterbauer B.a

Author affiliations

Departments of aNeurosurgery, bMedicine I/Institute of Cancer Research, cRadiology and dRadiotherapy, and eInstitute of Neurology, Medical University Vienna, Vienna, and fDepartment of Radiooncology, Academic Teaching Hospital, Feldkirch, Austria

Related Articles for ""

Stereotact Funct Neurosurg 2016;94:265-272

Do you have an account?

Login Information





Contact Information










I have read the Karger Terms and Conditions and agree.



Login Information





Contact Information










I have read the Karger Terms and Conditions and agree.



To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.
Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00


Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Clinical Study

Received: November 30, 2015
Accepted: August 04, 2016
Published online: October 08, 2016
Issue release date: October 2016

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 2

ISSN: 1011-6125 (Print)
eISSN: 1423-0372 (Online)

For additional information: https://www.karger.com/SFN

Abstract

Background: We evaluated Gamma Knife radiosurgery (GKRS) as a treatment option for patients with recurrent glioblastoma. Patients and Methods: 42 patients with histopathologically diagnosed recurrent grade IV tumor were treated with GKRS. All patients had undergone standard multimodal first-line treatment. The average time from diagnosis to GKRS was 17.0 months. The median target volume was 5.1 cm3. The median margin dose was 10 Gy and the median central dose 20 Gy. In a subset of patients, O6-methylguanine methyltransferase (MGMT) promoter methylation analysis by pyrosequencing was performed. Results: Most patients did not develop complications after GKRS. Time to radiological progression after initial GKRS was 4.4 months (95% CI: 3.1-5.7 months). Radiological progression mainly occurred beyond the GKRS-irradiated area. The median survival time after initial GKRS was 9.6 months (95% CI: 7.7-11.5 months). The median overall survival time from diagnosis was 25.6 months (95% CI: 21.8-29.3 months). Patients with MGMT promoter methylation survived significantly longer (33.4 months; 95% CI: 21.2-45.5 months) compared to patients without MGMT promoter methylation (16.0 months; 95% CI: 8.0-23.9 months). Conclusion: GKRS seems to be a relatively safe salvage treatment option for recurrent glioblastoma for highly selected patients but must be seen as part of a multimodal treatment algorithm.

© 2016 S. Karger AG, Basel


References

  1. Skeie BS, Enger PO, Brogger J, et al: Gamma knife surgery versus reoperation for recurrent glioblastoma multiforme. World Neurosurg 2012;78:658-669.
  2. Stupp R, Hegi ME, Mason WP, et al: Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009;10:459-466.
  3. Stupp R, Weber DC: The role of radio- and chemotherapy in glioblastoma. Onkologie 2005;28:315-317.
  4. Stark AM, van de Bergh J, Hedderich J, et al: Glioblastoma: clinical characteristics, prognostic factors and survival in 492 patients. Clin Neurol Neurosurg 2012;114:840-845.
  5. Stummer W, Kamp MA: The importance of surgical resection in malignant glioma. Curr Opin Neurol 2009;22:645-649.
  6. Tonn JC, Stummer W: Fluorescence-guided resection of malignant gliomas using 5-aminolevulinic acid: practical use, risks, and pitfalls. Clin Neurosurg 2008;55:20-26.
    External Resources
  7. Pichler J, Marosi C: Drug therapy of patients with recurrent glioblastoma: is there any evidence? Wien Med Wochenschr 2011;161:26-31.
  8. Barker CA, Chang M, Chou JF, et al: Radiotherapy and concomitant temozolomide may improve survival of elderly patients with glioblastoma. J Neurooncol 2012;109:391-397.
  9. De Bonis P, Fiorentino A, Anile C, et al: The impact of repeated surgery and adjuvant therapy on survival for patients with recurrent glioblastoma. Clin Neurol Neurosurg 2013;115:883-886.
  10. Elliott RE, Parker EC, Rush SC, et al: Efficacy of gamma knife radiosurgery for small-volume recurrent malignant gliomas after initial radical resection. World Neurosurg 2011;76:128-140.
  11. Chamberlain MC: Neuro-oncology: a selected review of ASCO 2011 abstracts. Expert Rev Neurother 2011;11:1371-1377.
  12. Hofer S, Elandt K, Greil R, et al: Clinical outcome with bevacizumab in patients with recurrent high-grade glioma treated outside clinical trials. Acta Oncol 2011;50:630-635.
  13. Murovic JA, Chang SD: Outcomes after stereotactic radiosurgery and various adjuvant treatments for recurrent glioblastoma multiforme: a current literature review and comparison of multiple factors that impact outcome. World Neurosurg 2012;78:588-591.
  14. Park KJ, Kano H, Iyer A, et al: Salvage gamma knife stereotactic radiosurgery followed by bevacizumab for recurrent glioblastoma multiforme: a case-control study. J Neurooncol 2012;107:323-333.
  15. Kim HS, Goh MJ, Kim N, Choi CG, Kim SJ, Kim JH: Which combination of MR imaging modalities is best for predicting recurrent glioblastoma? Study of diagnostic accuracy and reproducibility. Radiology 2014;273:831-843.
  16. Blasel S, Zagorcic A, Jurcoane A, Bähr O, Wagner M, Harter PN, Hattingen E: Perfusion MRI in the evaluation of suspected glioblastoma recurrence. J Neuroimaging 2016;26:116-123.
  17. Kim HS, Suh CH, Kim N, Choi CG, Kim SJ: Histogram analysis of intravoxel incoherent motion for differentiating recurrent tumor from treatment effect in patients with glioblastoma: initial clinical experience. AJNR Am J Neuroradiol 2014;35:490-497.
  18. Karnofsky DA, Burchenal JH: The clinical evaluation of chemotherapeutic agents in cancer; in MacLeod CM (ed): Evaluation of Chemotherapeutic Agents. New York, Columbia University Press, 1949, p 196.
  19. Preusser M, Berghoff AS, Manzl C, et al: Clinical neuropathology practice news 1-2014: pyrosequencing meets clinical and analytical performance criteria for routine testing of MGMT promoter methylation status in glioblastoma. Clin Neuropathol 2014;33:6-14.
  20. Reifenberger G, Hentschel B, Felsberg J, et al: Predictive impact of MGMT promoter methylation in glioblastoma of the elderly. Int J Cancer 2012;131:1342-1350.
  21. Fazeny-Dorner B, Veitl M, Wenzel C, et al: Survival with dacarbazine and fotemustine in newly diagnosed glioblastoma multiforme. Br J Cancer 2003;88:496-501.
  22. Jason GW, Pajurkova EM, Taenzer PA, et al: Acute effects on neuropsychological function and quality of life by high-dose multiple daily fractionated radiotherapy for malignant astrocytomas: assessing the tolerability of a new radiotherapy regimen. Psychooncology 1997;6:151-157.
  23. Mayer R, Sminia P: Reirradiation tolerance of the human brain. Int J Radiat Oncol Biol Phys 2008;70:1350-1360.
  24. Stark AM, Hedderich J, Held-Feindt J, et al: Glioblastoma - the consequences of advanced patient age on treatment and survival. Neurosurg Rev 2007;30:56-61.
  25. Souhami L, Seiferheld W, Brachman D, 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.
  26. Biswas T, Okunieff P, Schell MC, et al: Stereotactic radiosurgery for glioblastoma: retrospective analysis. Radiat Oncol 2009;4:11.
  27. Hsieh PC, Chandler JP, Bhangoo S, et al: Adjuvant gamma knife stereotactic radiosurgery at the time of tumor progression potentially improves survival for patients with glioblastoma multiforme. Neurosurgery 2005;57:684-692.
  28. Kondziolka D, Flickinger JC, Bissonette DJ, et al: Survival benefit of stereotactic radiosurgery for patients with malignant glial neoplasms. Neurosurgery 1997;41:776-783.
  29. Pouratian N, Crowley RW, Sherman JH, et al: Gamma Knife radiosurgery after radiation therapy as an adjunctive treatment for glioblastoma. J Neurooncol 2009;94:409-418.
  30. Combs SE, Widmer V, Thilmann C, et al: Stereotactic radiosurgery (SRS): treatment option for recurrent glioblastoma multiforme (GBM). Cancer 2005;104:2168-2173.
  31. Crowley RW, Pouratian N, Sheehan JP: Gamma knife surgery for glioblastoma multiforme. Neurosurg Focus 2006;20:E17.
  32. Sirin S, Oysul K, Surenkok S, et al: Linear accelerator-based stereotactic radiosurgery in recurrent glioblastoma: a single center experience. Vojnosanit Pregl 2011;68:961-966.
  33. Stummer W, Pichlmeier U, Meinel T, et al: Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 2006;7:392-401.
  34. Stupp R, Mason WP, van den Bent MJ, et al: Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005;352:987-996.
  35. Hegi ME, Diserens AC, Gorlia T, et al: MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 2005;352:997-1003.
  36. Malmstrom A, Gronberg BH, Marosi C, et al: Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol 2012;13:916-926.
  37. Preusser M, de Ribaupierre S, Wohrer A, et al: Current concepts and management of glioblastoma. Ann Neurol 2011;70:9-21.
  38. Kondziolka D, Somaza S, Martinez AJ, et al: Radioprotective effects of the 21-aminosteroid U-74389G for stereotactic radiosurgery. Neurosurgery 1997;41:203-208.
  39. Mehta MP, Masciopinto J, Rozental J, et al: Stereotactic radiosurgery for glioblastoma multiforme: report of a prospective study evaluating prognostic factors and analyzing long-term survival advantage. Int J Radiat Oncol Biol Phys 1994;30:541-549.
  40. Shenouda G, Souhami L, Podgorsak EB, et al: Radiosurgery and accelerated radiotherapy for patients with glioblastoma. Can J Neurol Sci 1997;24:110-115.
  41. Shrieve DC, Alexander E, Wen PY, et al: Comparison of stereotactic radiosurgery and brachytherapy in the treatment of recurrent glioblastoma multiforme. Neurosurgery 1995;36:275-282.
  42. Tsao MN, Mehta MP, Whelan TJ, et al: 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.
  43. Wong ET, Hess KR, Gleason MJ, et al: Outcomes and prognostic factors in recurrent glioma patients enrolled onto phase II clinical trials. J Clin Oncol 1999;17:2572-2578.
    External Resources

Article / Publication Details

First-Page Preview
Abstract of Clinical Study

Received: November 30, 2015
Accepted: August 04, 2016
Published online: October 08, 2016
Issue release date: October 2016

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 2

ISSN: 1011-6125 (Print)
eISSN: 1423-0372 (Online)

For additional information: https://www.karger.com/SFN


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.