title: Stereotactic radiosurgery (SRS) in high-grade glioma: judicious selection of small target volumes improves results.
abstract: We present a retrospective review of 55 Stereotactic Radiosurgery (SRS) procedures performed in 47 consecutive patients with high-grade glioma (HGG). Thirty-three (70.2%) patients were diagnosed with glioblastoma and 14 (29.8%) with grade III glioma. The indications for SRS were small (up to 30 mm in diameter) locally progressing lesions in 32/47 (68%) or new distant lesions in 15/47 (32%) patients. The median target volume was 2.2 cc (0.2-9.5 cc) and the median prescription dose was 18 Gy (14-24 Gy). Three patients (5.5% incidence in 55 treatments) developed radiation necrosis. In eight cases (17%) patients received a second salvage SRS treatment to nine new lesions detected during follow-up. In 22/55 SRS treatments (40.0%) patients received concurrent chemo- or biological therapy, including temozolamide (TMZ) (15 patients), bevacizumab (BVZ) (6 patients) and carboplatin in one patient. Median time to progression after SRS was 5.0 months (1.0-96.4). Median survival time after SRS was 15.9 months (2.3-109.3) overall median survival (since diagnosis) was 37.4 months (9.6-193.6 months). Long-lasting responses (>12 months) after SRS were observed in 25/46 (54.3%) patients. We compared a matched (histology, age, KPS) cohort of patients with recurrent HGG treated with BVZ alone with the current study group. Median survival was significantly longer for SRS treated patients compared to the BVZ only cohort (12.6 vs. 7.3 months, p = 0.0102). SRS may be considered an effective salvage procedure for selected patients with small volume, recurrent high-grade gliomas. Long-term radiological control was observed in more than 50% of the patients.
authors.affiliation: Neuro-Oncology Unit, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Felix
authors.initials: F
authors.lastname: Bokstein
authors.affiliation: Neuro-Oncology Unit, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Deborah T
authors.initials: DT
authors.lastname: Blumenthal
authors.affiliation: Institute of Radiotherapy, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.|Stereotactic Radiosurgery Unit, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Corn
authors.affiliation: Institute of Radiotherapy, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.|Stereotactic Radiosurgery Unit, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eliahu
authors.initials: E
authors.lastname: Gez
authors.affiliation: Institute of Radiotherapy, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.|Stereotactic Radiosurgery Unit, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Diana
authors.initials: D
authors.lastname: Matceyevsky
authors.affiliation: Institute of Radiotherapy, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.|Stereotactic Radiosurgery Unit, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Natan
authors.initials: N
authors.lastname: Shtraus
authors.affiliation: Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Ram
authors.affiliation: Stereotactic Radiosurgery Unit, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel. andrewk@tasmc.health.gov.il.|Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel. andrewk@tasmc.health.gov.il.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Kanner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D016634:Radiosurgery; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D047368:Tumor Burden; D055815:Young Adult
keywords: Glioblastoma multiforme; High grade glioma; Stereotactic radiosurgery; Temozolamide