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Purpose Salvage options for recurrent high-grade gliomas (HGGs) are limited by cumulative toxicity and limited efficacy despite advances in chemotherapeutic and radiotherapeutic techniques. Previous studies have reported encouraging survival results and favorable toxicity with fractionated stereotactic radiotherapy, and small studies have shown similar benefit using a shortened course of hypofractionated stereotactic radiation therapy (H-SRT). We sought to determine the efficacy and toxicity profile of H-SRT alone or in addition to repeat craniotomy or concomitant chemotherapy. Patients and Methods Between 1994 and 2008, 147 patients with recurrent HGG were treated with H-SRT (median dose, 35 Gy in 3.5-Gy fractions). Cox regression models were used to analyze survival outcomes. Variables included age, surgery before H-SRT, time to first recurrence, reirradiation dose, inclusion of chemotherapy with H-SRT, and gross tumor volume (GTV). Results Younger age (P = .001), smaller GTV (P = .025), and shorter time between diagnosis and recurrence (P = .034) were associated with improvement in survival from H-SRT. Doses of radiation ≥ 35 Gy approached significance (P = .07). There was no significant benefit of surgical resection or chemotherapy in this population when analysis was controlled for other prognostic factors. Conclusion H-SRT was well tolerated and resulted in a median survival time of 11 months after H-SRT, independent of re-operation or concomitant chemotherapy. Patients who experienced recurrence within 6 months after initial treatment had an excellent response and should not be disqualified from H-SRT. This is the largest series to examine the efficacy and tolerability of H-SRT in recurrent HGG.

Purpose Intra-operative (real-time) treatment planning has been adapted by many institutions for low–dose rate prostate brachytherapy. Although this allows dosimetric planning to be done during the procedure, preplan imaging to obtain a prostate volume is essential to identify the number of seeds to ensure adequate volume coverage. Currently, there is no consensus regarding the most appropriate imaging to obtain this information. We conducted a retrospective study to compare how volumes obtained from preplan CT (p-CT) scans or preplan transrectal ultrasound (p-TRUS) correlated with real-time ultrasound and postimplant CT volumes and the difference in accuracy of seed estimation between these techniques. Methods and Materials Ninety-two patients underwent 125 I permanent seed implants at Thomas Jefferson University Hospital between February 2002 and August 2008. Fifty-one patients underwent p-TRUS before intra-operative planning and 41 patients were evaluated by p-CT. Results The median difference in volume between preimplant imaging and the intra-operative planning ultrasound was 3.59 and 5.2 cc for patients who underwent p-TRUS and p-CT, respectively. p-TRUS volumes more closely correlated with real-time intra-operative volumes ( R = 0.84 in all patients and R = 0.91 in hormone-naive patients) vs. p-CT ( R = 0.82). The median number of seeds wasted using p-CT was 18 vs. 7 using volumes derived from p-TRUS. Conclusions The number of seeds ordered could be more accurately obtained from p-TRUS volumes, and this translated into less seed wastage. Our findings indicate that p-TRUS is a more accurate and an economically superior alternative to p-CT imaging in the era of real-time ultrasound planning.