Adomas Bunevicius1, Stylianos Pikis1, Douglas Kondziolka2, Dev N Patel2, Kenneth Bernstein3, Erik P Sulman3, Cheng-Chia Lee4,5, Huai-Che Yang5, Violaine Delabar6, David Mathieu6, Christopher P Cifarelli7, David E Arsanious7, Basem A Dahshan8, Joshua S Weir8, Herwin Speckter9, Angel Mota9, Manjul Tripathi10, Narendra Kumar11, Ronald E Warnick12, Selcuk Peker13, Yavuz Samanci13, Gene Barnett14, Farid El Hefnawi14, Ghusn Al Sideiri14, Jason Sheehan15,16. 1. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA. 2. Department of Neurosurgery, NYU Langone Health, New York, USA. 3. Department of Radiation Oncology, NYU Langone Health, New York, USA. 4. Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan. 5. School of Medicine, National Yang-Ming University, Taipei, Taiwan. 6. Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada. 7. Department of Neurosurgery, West Virginia University, Morgantown, WV, USA. 8. Department of Radiation Oncology, West Virginia University, Morgantown, WV, USA. 9. Gamma Knife, Radiology Department, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic. 10. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 11. Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 12. Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, OH, USA. 13. Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey. 14. Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA. 15. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA. jsheehan@virginia.edu. 16. Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, 22908, USA. jsheehan@virginia.edu.
Abstract
OBJECTIVE: Isocitrate dehydrogenase (IDH) mutation status is recommended used for diagnosis and prognostication of glioblastoma patients. We studied efficacy and safety of stereotactic radiosurgery (SRS) for patients with recurrent IDH-wt glioblastoma. METHODS: Consecutive patients treated with SRS for IDH-wt glioblastoma were pooled for this retrospective observational international multi-institutional study from institutions participating in the International Radiosurgery Research Foundation. RESULTS: Sixty patients (median age 61 years) underwent SRS (median dose 15 Gy and median treatment volume: 7.01 cm3) for IDH-wt glioblastoma. All patients had histories of surgery and chemotherapy with temozolomide, and 98% underwent fractionated radiation therapy. MGMT status was available for 42 patients, of which half of patients had MGMT mutant glioblastomas. During median post-SRS imaging follow-up of 6 months, 52% of patients experienced tumor progression. Median post-SRS progression free survival was 4 months. SRS prescription dose of > 14 Gy predicted longer progression free survival [HR 0.357 95% (0.164-0.777) p = 0.009]. Fifty-percent of patients died during post-SRS clinical follow-up that ranged from 1 to 33 months. SRS treatment volume of > 5 cc emerged as an independent predictor of shorter post-SRS overall survival [HR 2.802 95% CI (1.219-6.444) p = 0.02]. Adverse radiation events (ARE) suggestive of radiation necrosis were diagnosed in 6/55 (10%) patients and were managed conservatively in the majority of patients. CONCLUSIONS: SRS prescription dose of > 14 Gy is associated with longer progression free survival while tumor volume of > 5 cc is associated with shorter overall survival after SRS for IDH-wt glioblastomas. AREs are rare and are typically managed conservatively.
OBJECTIVE: Isocitrate dehydrogenase (IDH) mutation status is recommended used for diagnosis and prognostication of glioblastoma patients. We studied efficacy and safety of stereotactic radiosurgery (SRS) for patients with recurrent IDH-wt glioblastoma. METHODS: Consecutive patients treated with SRS for IDH-wt glioblastoma were pooled for this retrospective observational international multi-institutional study from institutions participating in the International Radiosurgery Research Foundation. RESULTS: Sixty patients (median age 61 years) underwent SRS (median dose 15 Gy and median treatment volume: 7.01 cm3) for IDH-wt glioblastoma. All patients had histories of surgery and chemotherapy with temozolomide, and 98% underwent fractionated radiation therapy. MGMT status was available for 42 patients, of which half of patients had MGMT mutant glioblastomas. During median post-SRS imaging follow-up of 6 months, 52% of patients experienced tumor progression. Median post-SRS progression free survival was 4 months. SRS prescription dose of > 14 Gy predicted longer progression free survival [HR 0.357 95% (0.164-0.777) p = 0.009]. Fifty-percent of patients died during post-SRS clinical follow-up that ranged from 1 to 33 months. SRS treatment volume of > 5 cc emerged as an independent predictor of shorter post-SRS overall survival [HR 2.802 95% CI (1.219-6.444) p = 0.02]. Adverse radiation events (ARE) suggestive of radiation necrosis were diagnosed in 6/55 (10%) patients and were managed conservatively in the majority of patients. CONCLUSIONS: SRS prescription dose of > 14 Gy is associated with longer progression free survival while tumor volume of > 5 cc is associated with shorter overall survival after SRS for IDH-wt glioblastomas. AREs are rare and are typically managed conservatively.
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