title: Stereotactic radiosurgery for recurrent malignant gliomas.
abstract: OBJECTIVE
  To evaluate the role of stereotactic radiosurgery in the management of recurrent malignant gliomas.
  
  
  METHODS
  We treated 35 patients with large (median treatment volume, 28 cm3) recurrent tumors that had failed to respond to conventional treatment. Twenty-six patients (74%) had glioblastomas multiforme (GBM) and nine (26%) had anaplastic astrocytomas (AA).
  
  
  RESULTS
  The mean time from diagnosis to radiosurgery was 10 months (range, 1 to 36), from radiosurgery to death, 8.0 months (range, 1 to 23). Twenty-one GBM (81%) and six AA (67%) patients have died. The actuarial survival time for all patients was 21 months from diagnosis and 8 months from radiosurgery. Twenty-two of 26 patients (85%) died of local or marginal failure, three (12%) of noncontiguous failure, and one (4%) of CSF dissemination. Age (P = .0405) was associated with improved survival on multivariate analysis, and age (P = .0110) and Karnofsky performance status (KPS) (P = .0285) on univariate analysis. Histology, treatment volume, and treatment dose were not significant variables by univariate analysis. Seven patients required surgical resection for increasing mass effect a mean of 4.0 months after radiosurgery, for an actuarial reoperation rate of 31%. Surgery did not significantly influence survival. At surgery, four patients had recurrent tumor, two had radiation necrosis, and one had both tumor and necrosis. The actuarial necrosis rate was 14% and the pathologic findings could have been predicted by the integrated logistic formula for developing symptomatic brain injury.
  
  
  CONCLUSIONS
  Stereotactic radiosurgery appears to prolong survival for recurrent malignant gliomas and has a lower reoperative rate for symptomatic necrosis than does brachytherapy. Patterns of failure are similar for both of these techniques.
authors.affiliation: Department of Neurosurgery, University of Minnesota Hospital and Clinic, Minneapolis 55455, USA.
authors.forename: W A
authors.initials: WA
authors.lastname: Hall
authors.forename: H R
authors.initials: HR
authors.lastname: Djalilian
authors.forename: P W
authors.initials: PW
authors.lastname: Sperduto
authors.forename: K H
authors.initials: KH
authors.lastname: Cho
authors.forename: B J
authors.initials: BJ
authors.lastname: Gerbi
authors.forename: J P
authors.initials: JP
authors.lastname: Gibbons
authors.forename: M
authors.initials: M
authors.lastname: Rohr
authors.forename: H B
authors.initials: HB
authors.lastname: Clark
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D012086:Reoperation; D016896:Treatment Outcome