Abstract
Glioblastoma (GBM) is the most common primary malignant brain tumor in adults and one of the most aggressive of all human cancers. GBM tumors are highly infiltrative and relatively resistant to conventional therapies. Aggressive management of GBM using a combination of surgical resection, followed by fractionated radiotherapy and chemotherapy has been shown to improve overall survival; however, GBM tumors recur in the majority of patients and the disease is most often fatal. There is a need to develop new treatment regimens and technological innovations to improve the overall survival of GBM patients. The role of stereotactic radiosurgery (SRS) for the treatment of GBM has been explored and is controversial. SRS utilizes highly precise radiation techniques to allow dose escalation and delivery of ablative radiation doses to the tumor while minimizing dose to the adjacent normal structures. In some studies, SRS with concurrent chemotherapy has shown improved local control with acceptable toxicities in select GBM patients. However, because GBM is a highly infiltrative disease, skeptics argue that local therapies, such as SRS, do not improve overall survival. The purpose of this article is to review the literature regarding SRS in both newly diagnosed and recurrent GBM, to describe SRS techniques, potential eligible SRS candidates, and treatment-related toxicities. In addition, this article will propose promising areas for future research for SRS in the treatment of GBM.
Highlights
BackgroundGlioblastoma (GBM) is the most common primary malignant brain tumor and is one of the most aggressive of all human cancers
stereotactic radiosurgery (SRS) was delivered prior to conventional radiation therapy, and that perhaps the alternative strategy to consider is to complete conventional radiotherapy and temozolomide and use SRS boost as a randomized comparator only in those patients whose disease has not progressed, thereby allowing the selection of a cohort of patients most likely to benefit from SRS [8]
A more limited number of small studies have suggested optimistic outcomes following SRS alone in patients with newly diagnosed GBM [20,21,22]. These data suggest a potential benefit of SRS with concurrent chemotherapy, preferably temozolomide, in newly diagnosed GBM with favorable prognostic factors, including an extensive resection with limited residual tumor volume, young age, and high Karnofsky performance status (KPS) [23]. These studies are weakened by their small size and concerns, such as selection bias; in the absence of additional higherlevel data, at present SRS alone or as a boost following external beam radiation therapy is not considered a standard therapy in patients with newly diagnosed GBM
Summary
Glioblastoma (GBM) is the most common primary malignant brain tumor and is one of the most aggressive of all human cancers. Quality of life and cognitive outcomes were comparable between the two groups Negative as these results are, they are less directly applicable to the current standard of care management, which involves concurrent and adjuvant temozolomide, a regimen more likely to control infiltrative microscopic disease beyond the SRS boost region [23]. SRS was delivered prior to conventional radiation therapy, and that perhaps the alternative strategy to consider is to complete conventional radiotherapy and temozolomide and use SRS boost as a randomized comparator only in those patients whose disease has not progressed, thereby allowing the selection of a cohort of patients most likely to benefit from SRS [8] Another multi-institutional study, RTOG 0023, a Phase II study, enrolled 76 patients with newly diagnosed GBM with < 6 cm of residual contrast-enhancing tumor and provided intriguing insights for patient selection [8].
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