title: Hypofractionated stereotactic radiotherapy in the management of recurrent glioma.
abstract: OBJECTIVE
  This study aimed to assess the efficacy and toxicity of hypofractionated stereotactic radiotherapy (SRT) in the management of patients with recurrent glioma.
  
  
  METHODS
  From January 1989 to July 1994, 36 patients with glioma were treated at the time of recurrence. Twenty-nine had recurrent high-grade astrocytoma, 3 high-grade oligodendroglioma, 1 high-grade ependymoma, and 3 pilocytic astrocytoma. Hypofractionated stereotactic radiotherapy was given using either three noncoplanar arcs or four to six noncoplanar fixed beams at 5 Gy/fraction, to doses ranging from 20 to 50 Gy initially on a dose escalation program. Two patients received 20 Gy, 8 received 30 Gy, 10 received 35 Gy, 10 received 40 Gy, 5 received 45 Gy, and 1 received 50 Gy, treating 5 days/week.
  
  
  RESULTS
  The median survival of 29 patients with recurrent high-grade astrocytoma was 11 months from the time of SRT. This compared to a median survival of 7 months for a cohort matched for age, performance status, and initial histologic grade who received nitrosourea-based chemotherapy at recurrence (p < 0.05). Initial low-grade astrocytoma histology was the only favorable prognostic factor for survival on univariate analysis. Three patients with recurrent oligodendroglioma remain alive 11, 23, and 34 months after SRT. Three children treated for recurrent pilocytic astrocytoma remain alive 14, 41, and 55 months following SRT. Presumed radiation damage, defined as reversible steroid-dependent toxicity, was observed in 13 patients (36%) and required reoperation in 2 (6%). A total dose of >40 Gy was a major predictor of radiation damage (p < 0.005).
  
  
  CONCLUSIONS
  Hypofractionated SRT is a noninvasive, well-tolerated, outpatient-based method of delivering palliative, high-dose, focal irradiation.
authors.affiliation: Neurooncology Unit, The Royal Marsden Hospital, Surrey, United Kingdom.
authors.forename: S F
authors.initials: SF
authors.lastname: Shepherd
authors.forename: R W
authors.initials: RW
authors.lastname: Laing
authors.forename: V P
authors.initials: VP
authors.lastname: Cosgrove
authors.forename: A P
authors.initials: AP
authors.lastname: Warrington
authors.forename: F
authors.initials: F
authors.lastname: Hines
authors.forename: S E
authors.initials: SE
authors.lastname: Ashley
authors.forename: M
authors.initials: M
authors.lastname: Brada
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery*; D011379:Prognosis; D016634:Radiosurgery; D016019:Survival Analysis