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. 2017 Jan 1;80(1):129-139.
doi: 10.1227/NEU.0000000000001344.

Indications and Efficacy of Gamma Knife Stereotactic Radiosurgery for Recurrent Glioblastoma: 2 Decades of Institutional Experience

Brandon S Imber  1 , Ishan Kanungo  2 , Steve Braunstein  3 , Igor J Barani  3 , Shannon E Fogh  3 , Jean L Nakamura  3 , Mitchel S Berger  2 , Edward F Chang  2 , Annette M Molinaro  2 , Juan R Cabrera  2 , Michael W McDermott  2 , Penny K Sneed  3 , Manish K Aghi  2
Affiliations

Indications and Efficacy of Gamma Knife Stereotactic Radiosurgery for Recurrent Glioblastoma: 2 Decades of Institutional Experience

Brandon S Imber et al. Neurosurgery. .

Abstract

Background: The role of stereotactic radiosurgery (SRS) for recurrent glioblastoma and the radionecrosis risk in this setting remain unclear.

Objective: To perform a large retrospective study to help inform proper indications, efficacy, and anticipated complications of SRS for recurrent glioblastoma.

Methods: We 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.

Results: One hundred seventy-four glioblastoma patients (median age, 54.1 years) underwent SRS a median of 8.7 months after initial diagnosis. Seventy-five percent had 1 treatment target (range, 1-6), and median target volume and prescriptions were 7.0 cm 3 (range, 0.3-39.0 cm 3 ) and 16.0 Gy (range, 10-22 Gy), respectively. Median overall survival was 10.6 months after SRS and 19.1 months 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 17.8 Gy; P = .003) and larger mean treatment volume (10.0 vs 5.4 cm 3 ; P = .009).

Conclusion: Gamma 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.

Keywords: Gamma knife; Glioblastoma; Radionecrosis; Recurrent; SRS; Stereotactic radiosurgery.

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Figures

FIGURE 1.
FIGURE 1.
Distribution of A marginal Gamma Knife (GK) dose and B maximal GK dose (Dmax) vs total GK treatment volume.
FIGURE 2.
FIGURE 2.
Kaplan-Meier OS estimates with a median follow-up time of 8.7 months after Gamma Knife (GK) with various subgroups, including A duration between initial pathological diagnosis and first GK session, B age at first GK session, and C marginal dose of the largest treated lesion.
See this image and copyright information in PMC

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