Hypofractionated stereotactic re-irradiation: treatment option in recurrent malignant glioma.

Dirk Vordermark,Oliver Kölbl,Klaus Bratengeier,Giles H Vince,Michael Flentje,Klemens Ruprecht

doi:10.1186/1471-2407-5-55

Abstract

BackgroundHypofractionated stereotactic radiotherapy (HFSRT) is one salvage treatment option in previously irradiated patients with recurrent malignant glioma. We analyzed the results of HFSRT and prognostic factors in a single-institution series.MethodsBetween 1997 and 2003, 19 patients with recurrent malignant glioma (14 glioblastoma on most recent histology, 5 anaplastic astrocytoma) were treated with HFSRT. The median interval from post-operative radiotherapy to HFSRT was 19 (range 3–116) months, the median daily single dose 5 (4–10) Gy, the median total dose 30 (20–30) Gy and the median planning target volume 15 (4–70) ml.ResultsThe median overall survival (OS) was 9.3 (1.9-77.6+) months from the time of HFSRT, 15.4 months for grade III and 7.9 months for grade IV tumors (p = 0.029, log-rank test). Two patients were alive at 34.6 and 77.6 months. OS was longer after a total dose of 30 Gy (11.1 months) than after total doses of <30 Gy (7.4 months; p = 0.051). Of five (26%) reoperations, none was performed for presumed or histologically predominant radiation necrosis. Median time to tumor progression after HFSRT on imaging was 4.9 months (1.3 to 37.3) months.ConclusionHFSRT with conservative total doses of no more than 30 Gy is safe and leads to similar OS times as more aggressive treatment schemes. In individual patients, HFSRT in combination with other salvage treatment modalities, was associated with long-term survival.

Highlights

Hypofractionated stereotactic radiotherapy (HFSRT) is one salvage treatment option in previously irradiated patients with recurrent malignant glioma
Single-dose radiosurgery, normofractionated and hypofractionated stereotactic radiotherapy have been investigated as a
Patients Between 1997 and 2003, 19 patients were treated with hypofractionated stereotactic radiotherapy (HFSRT) for recurrent malignant glioma at the University of Würzburg, Germany

Summary

Introduction

Hypofractionated stereotactic radiotherapy (HFSRT) is one salvage treatment option in previously irradiated patients with recurrent malignant glioma. Despite intensive multi-modality treatment including tumor resection, post-operative radiotherapy and frequently adjuvant chemotherapy, the prognosis of malignant glioma continues to be poor. Single-dose radiosurgery, normofractionated and hypofractionated stereotactic radiotherapy have been investigated as a (page number not for citation purposes). Median age (range) at time of HFSRT. Median Karnofsky performance score at time of HFSRT (range) (60–90). Most recent histology before HFSRT anaplastic astrocytoma III° glioblastoma multiforme IV°. Initial surgical procedure resection biopsy post-operative radiotherapy 1.8–2.0 Gy daily (total dose 54 to 61 Gy) 3 Gy daily (total dose 45 Gy) 2 × 1.8 Gy daily (total dose 54 Gy) salvage surgery before HFSRT 12 (63%)

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Discussion

Conclusion