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J Neurosurg. 2018 Oct 1:1-11. doi: 10.3171/2018.4.JNS172909. [Epub ahead of print]

Outcomes and prognostic stratification of patients with recurrent glioblastoma treated with salvage stereotactic radiosurgery.

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The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland.
Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, Toledo.
Department of Quantitative Health Sciences, Cleveland Clinic; and.
The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.



Glioblastoma (GBM) is the most malignant form of astrocytoma. The average survival is 6-10 months in patients with recurrent GBM (rGBM). In this study, the authors evaluated the role of stereotactic radiosurgery (SRS) in patients with rGBMs.


The authors performed a retrospective review of their brain tumor database (1997-2016). Overall survival (OS) and progression-free survival (PFS) after salvage SRS were the primary endpoints evaluated. Response to SRS was assessed using volumetric MR images.


Fifty-three patients with rGBM underwent salvage SRS targeting 75 lesions. The median tumor diameter and volume were 2.55 cm and 3.80 cm3, respectively. The median prescription dose was 18 Gy (range 12-24 Gy) and the homogeneity index was 1.90 (range 1.11-2.02). The median OS after salvage SRS was estimated to be 11.0 months (95% CI 7.1-12.2) and the median PFS after salvage SRS was 4.4 months (95% CI 3.7-5.0). A Karnofsky Performance Scale score ≥ 80 was independently associated with longer OS, while small tumor volume (< 15 cm3) and less homogeneous treatment plans (homogeneity index > 1.75) were both independently associated with longer OS (p = 0.007 and 0.03) and PFS (p = 0.01 and 0.002, respectively). Based on these factors, 2 prognostic groups were identified for PFS (5.4 vs 3.2 months), while 3 were identified for OS (median OS of 15.2 vs 10.5 vs 5.2 months).


SRS is associated with longer OS and/or PFS in patients with good performance status, small-volume tumor recurrences, and heterogeneous treatment plans. The authors propose a prognostic model to identify a cohort of rGBM patients who may benefit from SRS.


EBRT = external-beam radiotherapy; GBM = glioblastoma; GKRS = Gamma Knife radiosurgery; Gamma Knife; KPS = Karnofsky Performance Scale; LITT = laser interstitial thermal therapy; MGMT = O6-methylguanine-DNA methyltransferase; OS = overall survival; PFS = progression-free survival; RPA = recursive partitioning analysis; SRS = stereotactic radiosurgery; WBRT = whole-brain radiation therapy; brain tumor; glioblastoma; oncology; rGBM = recurrent GBM; recurrent GBM; salvage treatment; stereotactic radiosurgery


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