title: Salvage radiosurgery for selected patients with recurrent malignant gliomas.
abstract: OBJECTIVE
  To analyse the survival after salvage radiosurgery and to identify prognostic factors.
  
  
  METHODS
  We retrospectively reviewed 87 consecutive patients, with recurrent high-grade glioma, that underwent stereotactic radiosurgery between 1997 and 2010. We evaluated the survival after initial diagnosis and after reirradiation. The prognostic factors were analysed by bivariate and multivariate Cox regression model.
  
  
  RESULTS
  The median age was 48 years old. The primary histology included anaplastic astrocytoma (47%) and glioblastoma (53%). A margin dose of 18 Gy was administered in the majority of cases (74%). The median survival after initial diagnosis was 21 months (39 months for anaplastic astrocytoma and 18.5 months for glioblastoma) and after reirradiation it was 10 months (17 months for anaplastic astrocytoma and 7.5 months for glioblastoma). In the bivariate analyses, the prognostic factors significantly associated with survival after reirradiation were age, tumour and treatment volume at recurrence, recursive partitioning analyses classification, Karnofsky performance score, histology, and margin to the planning target volume. Only the last four showed significant association in the multivariate analyses.
  
  
  CONCLUSIONS
  stereotactic radiosurgery is a safe and may be an effective treatment option for selected patients diagnosed with recurrent high-grade glioma. The identified prognostic factors could help individualise the treatment.
authors.affiliation: Radiation Oncology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Martínez-Carrillo
authors.affiliation: Radiation Oncology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Tovar-Martín
authors.affiliation: Radiation Oncology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Zurita-Herrera
authors.affiliation: Radiation Oncology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Del Moral-Ávila
authors.affiliation: Radiation Oncology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Guerrero-Tejada
authors.affiliation: Neurosurgery Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Saura-Rojas
authors.affiliation: Medical Physics Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Osorio-Ceballos
authors.affiliation: Radiation Oncology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain.
authors.forename: Juan Pedro
authors.initials: JP
authors.lastname: Arrebola-Moreno
authors.affiliation: Radiation Oncology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Expósito-Hernández
mesh_terms: D005260:Female; D005910:Glioma / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011379:Prognosis; D016634:Radiosurgery; D016879:Salvage Therapy; D016896:Treatment Outcome