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

Mehul Patel, Farzan Siddiqui, JianYue Jin, Tom Mikkelsen, Mark Rosenblum, Benjamin Movsas, Samuel Ryu

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)185-191
Number of pages7
JournalJournal of Neuro-Oncology
Volume92
Issue number2
DOIs
StatePublished - Jan 1 2009

Fingerprint

Radiosurgery
Glioblastoma
Survival
Radiotherapy
Re-Irradiation
Neoplasms
Recurrence
Salvage Therapy
Lost to Follow-Up

Keywords

  • Glioblastoma
  • Radiosurgery
  • Radiotherapy
  • Recurrence
  • Reirradiation

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

Salvage reirradiation for recurrent glioblastoma with radiosurgery : Radiographic response and improved survival. / Patel, Mehul; Siddiqui, Farzan; Jin, JianYue; Mikkelsen, Tom; Rosenblum, Mark; Movsas, Benjamin; Ryu, Samuel.

In: Journal of Neuro-Oncology, Vol. 92, No. 2, 01.01.2009, p. 185-191.

Research output: Contribution to journalArticle

Patel, M, Siddiqui, F, Jin, J, Mikkelsen, T, Rosenblum, M, Movsas, B & Ryu, S 2009, 'Salvage reirradiation for recurrent glioblastoma with radiosurgery: Radiographic response and improved survival', Journal of Neuro-Oncology, vol. 92, no. 2, pp. 185-191. https://doi.org/10.1007/s11060-008-9752-9
Patel, Mehul ; Siddiqui, Farzan ; Jin, JianYue ; Mikkelsen, Tom ; Rosenblum, Mark ; Movsas, Benjamin ; Ryu, Samuel. / Salvage reirradiation for recurrent glioblastoma with radiosurgery : Radiographic response and improved survival. In: Journal of Neuro-Oncology. 2009 ; Vol. 92, No. 2. pp. 185-191.
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abstract = "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.",
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AU - Patel, Mehul

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AU - Jin, JianYue

AU - Mikkelsen, Tom

AU - Rosenblum, Mark

AU - Movsas, Benjamin

AU - Ryu, Samuel

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AB - 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.

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KW - Radiotherapy

KW - Recurrence

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