Cargando…

Salvage Fractionated Stereotactic Radiotherapy with or without Chemotherapy and Immunotherapy for Recurrent Glioblastoma Multiforme: A Single Institution Experience

BACKGROUND: The current standard of care for salvage treatment of glioblastoma multiforme (GBM) is gross total resection and adjuvant chemoradiation for operable patients. Limited evidence exists to suggest that any particular treatment modality improves survival for recurrent GBM, especially if ino...

Descripción completa

Detalles Bibliográficos
Autores principales: Hasan, Shaakir, Chen, Eda, Lanciano, Rachelle, Yang, Jun, Hanlon, Alex, Lamond, John, Arrigo, Stephen, Ding, William, Mikhail, Michael, Ghaneie, Arezoo, Brady, Luther
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432688/
https://www.ncbi.nlm.nih.gov/pubmed/26029663
http://dx.doi.org/10.3389/fonc.2015.00106
_version_ 1782371527799341056
author Hasan, Shaakir
Chen, Eda
Lanciano, Rachelle
Yang, Jun
Hanlon, Alex
Lamond, John
Arrigo, Stephen
Ding, William
Mikhail, Michael
Ghaneie, Arezoo
Brady, Luther
author_facet Hasan, Shaakir
Chen, Eda
Lanciano, Rachelle
Yang, Jun
Hanlon, Alex
Lamond, John
Arrigo, Stephen
Ding, William
Mikhail, Michael
Ghaneie, Arezoo
Brady, Luther
author_sort Hasan, Shaakir
collection PubMed
description BACKGROUND: The current standard of care for salvage treatment of glioblastoma multiforme (GBM) is gross total resection and adjuvant chemoradiation for operable patients. Limited evidence exists to suggest that any particular treatment modality improves survival for recurrent GBM, especially if inoperable. We report our experience with fractionated stereotactic radiotherapy (fSRT) with and without chemo/immunotherapy, identifying prognostic factors associated with prolonged survival. METHODS: From 2007 to 2014, 19 patients between 29 and 78 years old (median 55) with recurrent GBM following resection and chemoradiation for their initial tumor, received 18–35 Gy (median 25) in three to five fractions via CyberKnife fSRT. Clinical target volume (CTV) ranged from 0.9 to 152 cc. Sixteen patients received adjuvant systemic therapy with bevacizumab (BEV), temozolomide (TMZ), anti-epidermal growth factor receptor (125)I-mAb 425, or some combination thereof. RESULTS: The median overall survival (OS) from date of recurrence was 8 months (2.5–61) and 5.3 months (0.6–58) from the end of fSRT. The OS at 6 and 12 months was 47 and 32%, respectively. Three of 19 patients were alive at the time of this review at 20, 49, and 58 months from completion of fSRT. Hazard ratios for survival indicated that patients with a frontal lobe tumor, adjuvant treatment with either BEV or TMZ, time to first recurrence >16 months, CTV <36 cc, recursive partitioning analysis <5, and Eastern Cooperative Oncology Group performance status <2 were all associated with improved survival (P < 0.05). There was no evidence of radionecrosis for any patient. CONCLUSION: Radiation Therapy Oncology Group (RTOG) 1205 will establish the role of re-irradiation for recurrent GBM, however our study suggests that CyberKnife with chemotherapy can be safely delivered, and is most effective in patients with smaller frontal lobe tumors, good performance status, or long interval from diagnosis.
format Online
Article
Text
id pubmed-4432688
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-44326882015-05-29 Salvage Fractionated Stereotactic Radiotherapy with or without Chemotherapy and Immunotherapy for Recurrent Glioblastoma Multiforme: A Single Institution Experience Hasan, Shaakir Chen, Eda Lanciano, Rachelle Yang, Jun Hanlon, Alex Lamond, John Arrigo, Stephen Ding, William Mikhail, Michael Ghaneie, Arezoo Brady, Luther Front Oncol Oncology BACKGROUND: The current standard of care for salvage treatment of glioblastoma multiforme (GBM) is gross total resection and adjuvant chemoradiation for operable patients. Limited evidence exists to suggest that any particular treatment modality improves survival for recurrent GBM, especially if inoperable. We report our experience with fractionated stereotactic radiotherapy (fSRT) with and without chemo/immunotherapy, identifying prognostic factors associated with prolonged survival. METHODS: From 2007 to 2014, 19 patients between 29 and 78 years old (median 55) with recurrent GBM following resection and chemoradiation for their initial tumor, received 18–35 Gy (median 25) in three to five fractions via CyberKnife fSRT. Clinical target volume (CTV) ranged from 0.9 to 152 cc. Sixteen patients received adjuvant systemic therapy with bevacizumab (BEV), temozolomide (TMZ), anti-epidermal growth factor receptor (125)I-mAb 425, or some combination thereof. RESULTS: The median overall survival (OS) from date of recurrence was 8 months (2.5–61) and 5.3 months (0.6–58) from the end of fSRT. The OS at 6 and 12 months was 47 and 32%, respectively. Three of 19 patients were alive at the time of this review at 20, 49, and 58 months from completion of fSRT. Hazard ratios for survival indicated that patients with a frontal lobe tumor, adjuvant treatment with either BEV or TMZ, time to first recurrence >16 months, CTV <36 cc, recursive partitioning analysis <5, and Eastern Cooperative Oncology Group performance status <2 were all associated with improved survival (P < 0.05). There was no evidence of radionecrosis for any patient. CONCLUSION: Radiation Therapy Oncology Group (RTOG) 1205 will establish the role of re-irradiation for recurrent GBM, however our study suggests that CyberKnife with chemotherapy can be safely delivered, and is most effective in patients with smaller frontal lobe tumors, good performance status, or long interval from diagnosis. Frontiers Media S.A. 2015-05-15 /pmc/articles/PMC4432688/ /pubmed/26029663 http://dx.doi.org/10.3389/fonc.2015.00106 Text en Copyright © 2015 Hasan, Chen, Lanciano, Yang, Hanlon, Lamond, Arrigo, Ding, Mikhail, Ghaneie and Brady. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Hasan, Shaakir
Chen, Eda
Lanciano, Rachelle
Yang, Jun
Hanlon, Alex
Lamond, John
Arrigo, Stephen
Ding, William
Mikhail, Michael
Ghaneie, Arezoo
Brady, Luther
Salvage Fractionated Stereotactic Radiotherapy with or without Chemotherapy and Immunotherapy for Recurrent Glioblastoma Multiforme: A Single Institution Experience
title Salvage Fractionated Stereotactic Radiotherapy with or without Chemotherapy and Immunotherapy for Recurrent Glioblastoma Multiforme: A Single Institution Experience
title_full Salvage Fractionated Stereotactic Radiotherapy with or without Chemotherapy and Immunotherapy for Recurrent Glioblastoma Multiforme: A Single Institution Experience
title_fullStr Salvage Fractionated Stereotactic Radiotherapy with or without Chemotherapy and Immunotherapy for Recurrent Glioblastoma Multiforme: A Single Institution Experience
title_full_unstemmed Salvage Fractionated Stereotactic Radiotherapy with or without Chemotherapy and Immunotherapy for Recurrent Glioblastoma Multiforme: A Single Institution Experience
title_short Salvage Fractionated Stereotactic Radiotherapy with or without Chemotherapy and Immunotherapy for Recurrent Glioblastoma Multiforme: A Single Institution Experience
title_sort salvage fractionated stereotactic radiotherapy with or without chemotherapy and immunotherapy for recurrent glioblastoma multiforme: a single institution experience
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432688/
https://www.ncbi.nlm.nih.gov/pubmed/26029663
http://dx.doi.org/10.3389/fonc.2015.00106
work_keys_str_mv AT hasanshaakir salvagefractionatedstereotacticradiotherapywithorwithoutchemotherapyandimmunotherapyforrecurrentglioblastomamultiformeasingleinstitutionexperience
AT cheneda salvagefractionatedstereotacticradiotherapywithorwithoutchemotherapyandimmunotherapyforrecurrentglioblastomamultiformeasingleinstitutionexperience
AT lancianorachelle salvagefractionatedstereotacticradiotherapywithorwithoutchemotherapyandimmunotherapyforrecurrentglioblastomamultiformeasingleinstitutionexperience
AT yangjun salvagefractionatedstereotacticradiotherapywithorwithoutchemotherapyandimmunotherapyforrecurrentglioblastomamultiformeasingleinstitutionexperience
AT hanlonalex salvagefractionatedstereotacticradiotherapywithorwithoutchemotherapyandimmunotherapyforrecurrentglioblastomamultiformeasingleinstitutionexperience
AT lamondjohn salvagefractionatedstereotacticradiotherapywithorwithoutchemotherapyandimmunotherapyforrecurrentglioblastomamultiformeasingleinstitutionexperience
AT arrigostephen salvagefractionatedstereotacticradiotherapywithorwithoutchemotherapyandimmunotherapyforrecurrentglioblastomamultiformeasingleinstitutionexperience
AT dingwilliam salvagefractionatedstereotacticradiotherapywithorwithoutchemotherapyandimmunotherapyforrecurrentglioblastomamultiformeasingleinstitutionexperience
AT mikhailmichael salvagefractionatedstereotacticradiotherapywithorwithoutchemotherapyandimmunotherapyforrecurrentglioblastomamultiformeasingleinstitutionexperience
AT ghaneiearezoo salvagefractionatedstereotacticradiotherapywithorwithoutchemotherapyandimmunotherapyforrecurrentglioblastomamultiformeasingleinstitutionexperience
AT bradyluther salvagefractionatedstereotacticradiotherapywithorwithoutchemotherapyandimmunotherapyforrecurrentglioblastomamultiformeasingleinstitutionexperience