title: Increased survival using delayed gamma knife radiosurgery for recurrent high-grade glioma: a feasibility study.
abstract: OBJECTIVE
  The current study retrospectively assessed delayed gamma knife radiosurgery (GKRS) in the management of high-grade glioma recurrences.
  
  
  METHODS
  A total of 55 consecutive patients with high-grade glioma comprising 68 World Health Organization (WHO) III and WHO IV were treated with GKRS for local recurrences between 2001 and 2007. All patients had undergone microsurgery and radiochemotherapy, considered as standard therapy for high-grade glioma. Complete follow-up was available in all patients; median follow-up was 17.2 months (2.5-114.2 months). Median tumor volume was 5.2 mL, prescription dose was 20 Gy (14-22 Gy), and median max dose was 45 Gy (30-77.3 Gy).
  
  
  RESULTS
  The patients with WHO III tumors showed a median survival of 49.6 months with and a 2-year survival of 90%. After GKRS of the recurrences, these patients showed a median survival of 24.2 months and a 2-year survival of 50%. The patients with WHO IV tumors had a median survival of 24.5 months with a 2-year survival of 51.4%. After the recurrence was treated with GKRS, the median survival was 11.3 months and a 2-year survival: 22.9% for the WHO IV patients.
  
  
  CONCLUSIONS
  The current study shows a survival benefit for high-grade glioma recurrences when GKRS was administered after standard therapy. This is a relevant improvement compared with earlier studies that had had not been able to provide a beneficial effect timing radiosurgery in close vicinity to EBRT.
authors.affiliation: Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden. Electronic address: ernest.dodoo@karolinska.se.
authors.forename: Ernest
authors.initials: E
authors.lastname: Dodoo
authors.affiliation: Department of Neurosurgery, Aachen University Hospital, Aachen, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Huffmann
authors.affiliation: Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Inti
authors.initials: I
authors.lastname: Peredo
authors.affiliation: Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Hanne
authors.initials: H
authors.lastname: Grinaker
authors.affiliation: Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Georges
authors.initials: G
authors.lastname: Sinclair
authors.affiliation: Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA.
authors.forename: Theofilos
authors.initials: T
authors.lastname: Machinis
authors.affiliation: Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: Per Oyvind
authors.initials: PO
authors.lastname: Enger
authors.affiliation: Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: Bente Sandvei
authors.initials: BS
authors.lastname: Skeie
authors.affiliation: Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: Paal-Henning
authors.initials: PH
authors.lastname: Pedersen
authors.affiliation: Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Marcus
authors.initials: M
authors.lastname: Ohlsson
authors.affiliation: Department of Pathology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Abiel
authors.initials: A
authors.lastname: Orrego
authors.affiliation: Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kraepelien
authors.affiliation: Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Pierre
authors.initials: P
authors.lastname: Barsoum
authors.affiliation: Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Hamza
authors.initials: H
authors.lastname: Benmakhlouf
authors.affiliation: Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Herrman
authors.affiliation: Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Svensson
authors.affiliation: Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Bodo
authors.initials: B
authors.lastname: Lippitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D059248:Chemoradiotherapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods / Q000401:mortality*; D016019:Survival Analysis; D055815:Young Adult
keywords: Anaplastic glioma; GKRS; Gamma knife radiosurgery; Glioblastoma; HGG, high-grade glioma; Recurrent high-grade glioma; WHO III; WHO IV