Hypofractionated stereotactic re-irradiation: treatment option in recurrent malignant glioma.
BACKGROUND
Hypofractionated stereotactic radiotherapy (HFSRT) is one salvage treatment option in previously irradiated patients with recurrent malignant glioma. We analyzed the results of HFSRT and prognostic factors in a single-institution series.


METHODS
Between 1997 and 2003, 19 patients with recurrent malignant glioma (14 glioblastoma on most recent histology, 5 anaplastic astrocytoma) were treated with HFSRT. The median interval from post-operative radiotherapy to HFSRT was 19 (range 3-116) months, the median daily single dose 5 (4-10) Gy, the median total dose 30 (20-30) Gy and the median planning target volume 15 (4-70) ml.


RESULTS
The median overall survival (OS) was 9.3 (1.9-77.6+) months from the time of HFSRT, 15.4 months for grade III and 7.9 months for grade IV tumors (p = 0.029, log-rank test). Two patients were alive at 34.6 and 77.6 months. OS was longer after a total dose of 30 Gy (11.1 months) than after total doses of <30 Gy (7.4 months; p = 0.051). Of five (26%) reoperations, none was performed for presumed or histologically predominant radiation necrosis. Median time to tumor progression after HFSRT on imaging was 4.9 months (1.3 to 37.3) months.


CONCLUSIONS
HFSRT with conservative total doses of no more than 30 Gy is safe and leads to similar OS times as more aggressive treatment schemes. In individual patients, HFSRT in combination with other salvage treatment modalities, was associated with long-term survival.
Vordermark
Dirk
D
Dept. of Radiation Oncology, University of Würzburg, Germany. vordermark_d@klinik.uni-wuerzburg.de
Kölbl
Oliver
O
Ruprecht
Klemens
K
Vince
Giles H
GH
Bratengeier
Klaus
K
Flentje
Michael
M
D000970:Antineoplastic Agents / Q000494:pharmacology; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005909:Glioblastoma / Q000473:pathology / Q000601:surgery; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local; D015376:Nimustine / Q000494:pharmacology; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods*; D011878:Radiotherapy / Q000379:methods*; D012008:Recurrence; D013238:Stereotaxic Techniques; D013713:Teniposide / Q000494:pharmacology; D013997:Time Factors; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D015376:Nimustine; D013713:Teniposide