Stereotactic radiosurgery with oxygen radiosensitization in the treatment of multiforme glioblastoma

Abstract

Glioblastoma multiforme (mGBM) is the most frequent and most primary malignant neoplasm of the central nervous system. Despite current standard treatment protocols such as aggressive surgical resection, radiation therapy, and chemotherapy, the aggressive nature of mGBM results in poor survival. This is largely due to its radioresistance, due to the hypoxia of tumor cells, which are resistant to various chemotherapy regimens, including radiation therapy. Purpose. To assess the effectiveness of radiosurgical treatment of recurrence in patients with mGBM after surgical resection and chemotherapy, using oxygen radiosensitization. Materials and methods. Our study included 26 patients with relapsed mGBM who underwent SRS with oxygen radiosensitization. 12 patients were the control group, without radiosensitization. The study primarily determined the role of oxygen radiosensitization of the tumor, the dose of radiosurgical treatment, the volume of the tumor, and the degree of oxygenation according to MRI data (BOLD programs). Oxygenation was carried out using the Oxy 6000 oxygenator. The effectiveness of radiosurgical treatment was assessed by overall and recurrence-free survival, as well as by the degree of treatment toxicity. The results. Median overall survival (OSS) was 20 months in patients who received SRS with radiosensitization compared with 12 months in those who received SRS without radiosensitization. Relapse-free survival (FFS) in the study group was 15 months, against 8 in the control group (p = 0.004; X 2 = 8.166). Conclusion. SRS is a fairly effective and reliable strategy in the treatment of recurrence of glioblastoma multiforme after surgical resection of the tumor and chemoradiotherapy. Radiosensitization with oxygen during SRS of hypoxic radioresistant glioblastomas improves overall survival by 60.0% and recurrence-free survival by 53.3% compared to the control group. Oxygen is a powerful radiosensitizer that significantly increases the radiosensitivity of tumor cells by increasing the oxygen saturation of hypoxic cells.