J Korean Neurosurg Soc.  2018 Jul;61(4):516-524. 10.3340/jkns.2017.0259.

Efficacy of Gamma Knife Radiosurgery for Recurrent High-Grade Gliomas with Limited Tumor Volume

• Cheon YJ
• Jung TY
• Jung S
• Kim IY
• Moon KS
• Lim SH

• KMID: 2417329
• DOI: http://doi.org/10.3340/jkns.2017.0259

Abstract

OBJECTIVE
This study aims to determine whether gamma knife radiosurgery (GKR) improves survival in patients with recurrent highgrade gliomas.
METHODS
Twenty nine patients with recurrent high-grade glioma underwent 38 GKR. The male-to-female ratio was 10 : 19, and the median age was 53.8 years (range, 20-75). GKR was performed in 11 cases of recurrent anaplastic oligodendrogliomas, five anaplastic astrocytomas, and 22 glioblastomas. The median prescription dose was 16 Gy (range, 10-24), and the median target volume was 7.0 mL (range, 1.1-15.7). Of the 29 patients, 13 (44.8%) received concurrent chemotherapy. We retrospectively analyzed the progression-free survival (PFS) and overall survival (OS) after GKR depending on the Eastern Cooperative Oncology Group (ECOG) performance status (PS), pathology, concurrent chemotherapy, radiation dose, and target tumor volume.
RESULTS
Starting from when the patients underwent GKR, the median PFS and OS were 5.0 months (range, 1.1-28.1) and 13.0 months (range, 1.1-75.1), respectively. On univariate analysis, the median PFS was significantly long in patients with anaplastic oligodendroglioma, ECOG PS 1, and target tumor volume less than 10 mL (p < 0.05). Meanwhile, on multivariate analysis, patients with ECOG PS 1 and target tumor volume less than 10 mL showed improved PFS (p=0.043 and p=0.007, respectively). The median OS was significantly increased in patients with ECOG PS 1 and tumor volume less than 10 mL on univariate and multivariate analyses (p < 0.05).
CONCLUSION
GKR could be an additional treatment option in recurrent high-grade glioma, particularly in patients with good PS and limited tumor volume.

Keyword

Recurrence; Glioma; Gamma knife radiosurgery; Tumor volume

MeSH Terms

Astrocytoma
Disease-Free Survival
Drug Therapy
Glioblastoma
Glioma*
Humans
Multivariate Analysis
Oligodendroglioma
Pathology
Prescriptions
Radiosurgery*
Recurrence
Retrospective Studies
Tumor Burden*

Figure

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  Fig. 1. Kaplan-Meier curve related to progression-free survival. A : Median PFS was significantly longer in patients with anaplastic oligodendroglioma than in those with glioblastoma (p=0.001). B : Survival of patients with ECOG PS 1 was statistically significantly different compared to those with ECOG PS 3 (p=0.024). C : Survival of patients with tumor volume less than 10 mL was statistically significantly different compared to those with tumor volume over 10 mL (p=0.008). AO : anaplastic oligodendroglioma, AA : anaplastic astrocytoma, GM : glioblastoma; PFS : progression-free survival, ECOG : the Eastern Cooperative Oncology Group, PS : performance status.

• 

  Fig. 2. A : Kaplan-Meier curve related with overall survival. Patients with ECOG PS 1 and 2 had better OS compared to those with ECOG PS 3 (p=0.000 and 0.042, respectively). B : Patients with tumor volume less than 10 mL had better OS compared to those with tumor volume over 10 mL (p=0.002). ECOG : the Eastern Cooperative Oncology Group, PS : performance status, OS : overall survival.

• 

  Fig. 3. GKR for recurred glioblastoma. A : Brain MRI showed the recurred homogenous enhanced lesion on the parietal lobe. B : Methionine-PET image showed a hot uptake lesion. C : GKR was performed for this lesion. The tumor volume was 2.05 mL, and the marginal radiation dose was 18 Gy with 50% isodose. D : Follow-up brain MRI after 24 months showed a decreased enhancing lesion without any neurologic symptoms. GKR : gamma knife radiosurgery, MRI : magnetic resonance images, PET : positron emission tomography.

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  Fig. 4. GKR for recurred anaplastic oligodendroglioma. A : Brain MRI showed a non-enhancing lesion adjacent to the right frontal horn. B : Methionine-PET image showed a hot uptake lesion. C : GKR was performed. The tumor volume was 2.0 mL, and the marginal radiation dose was 18 Gy with 50% isodose. D : Follow-up brain MRI after 11.3 months showed a stable enhancing lesion without any neurologic symptoms. GKR : gamma knife radiosurgery, MRI : magnetic resonance images, PET : positron emission tomography.

Reference

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