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Indications and Efficacy of Gamma Knife Stereotactic Radiosurgery for Recurrent Glioblastoma: 2 Decades of Institutional Experience
- Source :
- Neurosurgery, vol 80, iss 1
- Publication Year :
- 2016
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2016.
-
Abstract
- BackgroundThe role of stereotactic radiosurgery (SRS) for recurrent glioblastoma and the radionecrosis risk in this setting remain unclear.ObjectiveTo perform a large retrospective study to help inform proper indications, efficacy, and anticipated complications of SRS for recurrent glioblastoma.MethodsWe retrospectively analyzed patients who underwent Gamma Knife SRS between 1991 and 2013. We used the partitioning deletion/substitution/addition algorithm to identify potential predictor covariate cut points and Kaplan-Meier and proportional hazards modeling to identify factors associated with post-SRS and postdiagnosis survival.ResultsOne hundred seventy-four glioblastoma patients (median age, 54.1years) underwent SRS a median of 8.7months after initial diagnosis. Seventy-five percent had 1 treatment target (range, 1-6), and median target volume and prescriptions were 7.0cm 3 (range, 0.3-39.0cm 3 ) and 16.0Gy (range, 10-22Gy), respectively. Median overall survival was 10.6months after SRS and 19.1months after diagnosis. Kaplan-Meier and multivariable modeling revealed that younger age at SRS, higher prescription dose, and longer interval between original surgery and SRS are significantly associated with improved post-SRS survival. Forty-six patients (26%) underwent salvage craniotomy after SRS, with 63% showing radionecrosis or mixed tumor/necrosis vs 35% showing purely recurrent tumor. The necrosis/mixed group had lower mean isodose prescription compared with the tumor group (16.2 vs 17.8Gy; P = .003) and larger mean treatment volume (10.0 vs 5.4cm 3 ; P = .009).ConclusionGamma Knife may benefit a subset of focally recurrent patients, particularly those who are younger with smaller recurrences. Higher prescriptions are associated with improved post-SRS survival and do not seem to have greater risk of symptomatic treatment effect.
- Subjects :
- Male
medicine.medical_treatment
Salvage therapy
0302 clinical medicine
80 and over
Young adult
Craniotomy
Cancer
Aged, 80 and over
Brain Neoplasms
Middle Aged
Treatment Outcome
Local
030220 oncology & carcinogenesis
Female
Recurrent
Adult
medicine.medical_specialty
Clinical Sciences
Gamma knife
Radiosurgery
Radionecrosis
Article
SRS
Young Adult
03 medical and health sciences
Rare Diseases
parasitic diseases
medicine
Humans
Stereotactic radiosurgery
Aged
Retrospective Studies
Salvage Therapy
Mixed tumor
Neurology & Neurosurgery
business.industry
Recurrent glioblastoma
Neurosciences
Retrospective cohort study
medicine.disease
Brain Disorders
Surgery
Brain Cancer
Neoplasm Recurrence
Neurology (clinical)
Neoplasm Recurrence, Local
Glioblastoma
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15244040 and 0148396X
- Volume :
- 80
- Database :
- OpenAIRE
- Journal :
- Neurosurgery
- Accession number :
- edsair.doi.dedup.....5948a55746518eccac18f8013f0831a2