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. 2025 May 5;17(5):e83511.
doi: 10.7759/cureus.83511. eCollection 2025 May.

Reirradiation of Large or Multifocal High-Grade Gliomas With Gyroscopic Radiosurgery in Combination With Modulated Electro-Hyperthermia

Morena Sallabanda  1 , Elisabeth Estefanía Arrojo Álvarez  2 , Borja Aguilar  3 , Ana Lucrecia Ruiz Echevarría  4 , Helena Huertas Modéjar  2 , Kita Sallabanda  5
Affiliations

Reirradiation of Large or Multifocal High-Grade Gliomas With Gyroscopic Radiosurgery in Combination With Modulated Electro-Hyperthermia

Morena Sallabanda et al. Cureus. .

Abstract

Introduction: High-grade gliomas (HGGs) are the most common primary malignant brain neoplasms in adults, with a high rate of local relapse in the first two years after primary treatment, resulting in poor prognosis. The aim of this study is to describe the potential benefits of the implementation of gyroscopic radiosurgery (GRS) in combination with modulated electro-hyperthermia (mEHT) as a radiosensitizer for the reirradiation of large or multifocal recurrent HGGs.

Methods: A study was designed to evaluate the impact of survival and clinical tolerance. Clinical information of 15 patients treated between April 2023 and September 2024 was analyzed.

Results: Fifteen patients with a median age of 50 years and grade 4 (n = 13) or grade 3 (n = 2) gliomas were included in the study. The median Karnofsky Performance Status (KPS) was 70. Multifocal disease was present in 10 patients. The median time from previous radiation was 16 months. Twelve patients were eligible for analysis. The median planning target volume (PTV) was 33.6 cc; 48% (10 lesions) received five fractions (20-30 Gy), 38% (eight lesions) received one fraction (15-18 Gy), and 14% (three lesions) received three fractions (24 Gy). mEHT was applied every 48 hours. The median follow-up was seven months with no in-field recurrences reported. Actuarial overall survival (OS) from GRS and mEHT was 58.3% at six months and 25% at 12 months. Acute tolerance was acceptable, with 33.3% of patients showing improvement, 33.3% remaining stable, and 33.3% presenting grade 2 radiation necrosis, managed with outpatient steroid adjustment.

Conclusions: High-risk, HGG reirradiation with GRS and mEHT showed a favorable impact on local control and OS with low toxicity. Longer follow-up and larger series are needed to validate these results.

Keywords: gyroscopic radiosurgery; high-grade glioma; modulated electro-hyperthermia; recurrence; reirradiation.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Dose distribution of a gyroscopic radiosurgery reirradiation in five fractions with a total dose of 30 Gy in a patient with recurrent glioblastoma.
Figure 2
Figure 2. Kaplan-Meier overall survival curve showing an actuarial median overall survival from gyroscopic radiosurgery and modulated electro-hyperthermia of seven months (95% CI 5.9–8.1 months).
See this image and copyright information in PMC

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