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Year : 2016  |  Volume : 12  |  Issue : 4  |  Page : 1243-1248

Salvage stereotactic radiosurgery for recurrent glioblastoma multiforme with prior radiation therapy

1 Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
2 Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

Correspondence Address:
Dwight E Heron
Department of Radiation Oncology, University of Pittsburgh Cancer Institute, 5230 Centre Avenue, Pittsburgh, PA 15232
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.199537

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Background: Glioblastoma multiforme (GBM) carries a poor prognosis with high recurrence rates. Salvage stereotactic radiosurgery (SRS) may be an effective treatment option. Methods: We retrospectively reviewed 34 patients (41 lesions) treated with salvage SRS for recurrent GBM between 2004 and 2012. Initial surgical treatments were gross total resection (58%), subtotal resection (STR) (24%), and biopsy (18%). All patients were treated with prior radiation therapy. Recurrent disease was treated with salvage SRS with a median dose and fractions of 23.4 Gy (range, 12–30) and 3 (range, 1–3), respectively. Cox proportional hazards regression was conducted to establish predictive factors (P ≤ 0.05) Results: Median follow-up from salvage SRS was 10.8 months (interquartile range [IQR], 7.0–15.6). The median time from initial radiation therapy to salvage SRS was 13.7 months (IQR, 2.9–25.0). The 6- and 12-month overall survival from salvage SRS were 84.9% and 42.5%, respectively. On univariate analysis, STR was associated with inferior survival from salvage SRS (P ≤ 0.05). The 6- and 12-month local control (LC) estimates were 63.1% and 16.4%, respectively. On univariate analysis, higher biological effective dose and prior temozolomide were associated with superior LC. Concerning toxicity, there were 4 (12%) grade 2 and 1 (3%) grade 3 adverse events within this patient series. No grade 4 or grade 5 toxicities were observed. Conclusion: Our outcomes suggest that SRS is a feasible treatment option with acceptable salvage survival rates, given the poor prognosis of this disease.

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