title: Radiosurgery reirradiation for high-grade glioma recurrence: a retrospective analysis.
abstract: Despite various treatment strategies being available, recurrent high-grade gliomas (r-HGG) are difficult to manage. To obtain local control, radiosurgery (SRS) reirradiation has been considered as potential treatment. In the present study, a retrospective analysis was performed on r-HGG patients treated with salvage single- (s-SRS) or multi-fraction SRS (m-SRS). The aim of this study was to evaluate the effectiveness of salvage SRS in terms of overall survival (OS); toxicity was analyzed as well. Between 2004 May and 2011 December, 128 r-HGG patients (161 lesions) treated with CyberKnife(®) SRS reirradiation were retrospectively analyzed. Toxicity was graded according to Radiation Therapy Oncology Group and by Common Terminology Criteria for Adverse Events v.3 criteria. OS from the diagnosis date and OS from reirradiation were estimated using the Kaplan-Meier method. Median follow-up was 9 months (range 15 days-82 months). All patients completed SRS without high-grade toxicity. Radiation necrosis was observed in seven patients (6 %) with large volume lesions. The median survival from initial diagnosis was 32 months. The 1-, 2-, and 3-years survival rates from diagnosis were 95, 62, and 45 % respectively. Median survival following SRS was 11.5 months. The 1-, 2-, and 3-years survival rate following SRS was 48, 20, and 17 % respectively. On multivariate analysis, age <40 years, salvage surgery before SRS, and other post-SRS therapies (second-line chemotherapy and/or surgery) were found to significantly improve survival (p = 0.03). SRS represents a safe and feasible option to treat r-HGG patients with low complication rates and potential survival benefit.
authors: Radiotherapy Unit, Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, MI, Italy, valentinapinzi@yahoo.it.
authors: Valentina
authors: V
authors: Pinzi
authors: Chiara
authors: C
authors: Orsi
authors: Marcello
authors: M
authors: Marchetti
authors: Ida Maddalena
authors: IM
authors: Milanesi
authors: Livia Corinna
authors: LC
authors: Bianchi
authors: Francesco
authors: F
authors: DiMeco
authors: Valeria
authors: V
authors: Cuccarini
authors: Mariangela
authors: M
authors: Farinotti
authors: Paolo
authors: P
authors: Ferroli
authors: Gaetano
authors: G
authors: Finocchiaro
authors: Angelo
authors: A
authors: Franzini
authors: MariaLuisa
authors: M
authors: Fumagalli
authors: Antonio
authors: A
authors: Silvani
authors: Laura
authors: L
authors: Fariselli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000628:therapy*; D005260:Female; D005910:Glioma / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D016634:Radiosurgery / Q000379:methods*; D000069475:Re-Irradiation / Q000379:methods; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D015898:Tomography Scanners, X-Ray Computed; D055815:Young Adult