title: Stereotactically guided fractionated re-irradiation in recurrent glioblastoma multiforme.
abstract: OBJECTIVE
  To assess the feasibility, efficacy and toxicity of fractionated stereotactic radiotherapy in the treatment of recurrent glioblastoma multiforme.
  
  
  METHODS
  From January 1995 to July 2003, 53 patients with histologically proven glioblastoma multiforme were treated at recurrence with fractionated stereotactic radiation therapy. A median dose of 36 Gy using a median fractionation of 5 x 2 Gy/week was applied.
  
  
  RESULTS
  Median overall survival was 21 months, and median overall survival from the time point of re-irradiation was 8 months. The median time interval between primary and secondary radiation therapy was 10 months. In this patient population, no variables predicting longer overall survival could be determined. However, neurosurgical resection at relapse was associated with increased survival after re-irradiation (p=0.04), but left progression-free survival unaltered. Treatment was well-tolerated and no severe toxicities developed.
  
  
  CONCLUSIONS
  Stereotactically guided fractionated re-irradiation is a safe and effective treatment modality in selected cases of recurring glioblastoma multiforme. Since this is not a randomized study, further evaluation in larger patient collectives is warranted. Also, based on recent results of radiochemotherapy in the treatment of primary glioblastoma multiforme, concomitant chemotherapy at relapse might be considered in the future.
authors.affiliation: Department of Radiation Oncology, German Cancer Research Center (DKFZ), INF 280, and University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Stephanie.Combs@med.uni-heidelberg.de
authors.forename: S E
authors.initials: SE
authors.lastname: Combs
authors.forename: S
authors.initials: S
authors.lastname: Gutwein
authors.forename: Ch
authors.initials: Ch
authors.lastname: Thilmann
authors.forename: P
authors.initials: P
authors.lastname: Huber
authors.forename: J
authors.initials: J
authors.lastname: Debus
authors.forename: D
authors.initials: D
authors.lastname: Schulz-Ertner
mesh_terms: D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D005720:Gamma Rays; D005909:Glioblastoma / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D019233:Retreatment; D012189:Retrospective Studies; D013238:Stereotaxic Techniques / Q000295:instrumentation; D015996:Survival Rate