Salvage Radiosurgery for Selected Patients with Recurrent Malignant Gliomas

Purpose. To analyse the survival after salvage radiosurgery and to identify prognostic factors.Methods. We retrospectively reviewed 87 consecutive patients, with recurrent high-grade glioma, that underwent stereotactic radiosurgery between 1997 and 2010. We evaluated the survival after initial diagnosis and after reirradiation. The prognostic factors were analysed by bivariate and multivariate Cox regression model.Results. The median age was 48 years old. The primary histology included anaplastic astrocytoma (47%) and glioblastoma (53%). A margin dose of 18 Gy was administered in the majority of cases (74%). The median survival after initial diagnosis was 21 months (39 months for anaplastic astrocytoma and 18.5 months for glioblastoma) and after reirradiation it was 10 months (17 months for anaplastic astrocytoma and 7.5 months for glioblastoma). In the bivariate analyses, the prognostic factors significantly associated with survival after reirradiation were age, tumour and treatment volume at recurrence, recursive partitioning analyses classification, Karnofsky performance score, histology, and margin to the planning target volume. Only the last four showed significant association in the multivariate analyses.Conclusion. stereotactic radiosurgery is a safe and may be an effective treatment option for selected patients diagnosed with recurrent high-grade glioma. The identified prognostic factors could help individualise the treatment.

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Individualized Nomogram for Predicting Survival in Patients with Brain Metastases After Stereotactic Radiosurgery Utilizing Driver Gene Mutations and Volumetric Surrogates

Frontiers in Oncology ◽

10.3389/fonc.2021.659538 ◽

2021 ◽

Vol 11 ◽

Author(s):

Cheng Zhou ◽

Changguo Shan ◽

Mingyao Lai ◽

Zhaoming Zhou ◽

Junjie Zhen ◽

...

Keyword(s):

Prognostic Factors ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Cox Regression ◽

Mutational Analysis ◽

Clinical Chemistry ◽

Personalized Treatment ◽

Serum Lactate Dehydrogenase ◽

Driver Gene ◽

Karnofsky Performance Score

It is well-known that genomic mutational analysis plays a significant role in patients with NSCLC for personalized treatment. Given the increasing use of stereotactic radiosurgery (SRS) for brain metastases (BM), there is an emerging need for more precise assessment of survival outcomes after SRS. Patients with BM and treated by SRS were eligible in this study. The primary endpoint was overall survival (OS). Cox regression models were used to identify independent prognostic factors. A survival predictive nomogram was developed and evaluated by Concordance-index (C-index), area under the curve (AUC), and calibration curve. From January 2016 to December 2019, a total of 356 BM patients were eligible. The median OS was 17.7 months [95% confidence interval (CI) 15.5–19.9] and the actual OS at 1- and 2-years measured 63.2 and 37.6%, respectively. A nomogram for OS was developed by incorporating four independent prognostic factors: Karnofsky Performance Score, cumulative tumor volume, gene mutation status, and serum lactate dehydrogenase. The nomogram was validated in a separate cohort and demonstrated good calibration and good discriminative ability (C-index = 0.780, AUC = 0.784). The prognostic accuracy of the nomogram (0.792) was considerably enhanced when compared with classical prognostic indices, including the Graded Prognostic Assessment (0.708), recursive partitioning analysis (0.587), and the SRS (0.536). Kaplan–Meier curves showed significant differences in OS among the stratified low-, median- and high-risk groups (P < 0.001). In conclusion, we developed and validated an individualized prognostic nomogram by integrating physiological, volumetric, clinical chemistry, and molecular biological surrogates. Although this nomogram should be validated by independent external study, it has a potential to facilitate more precise risk-stratifications to guide personalized treatment for BM.

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Gamma Knife Radiosurgery for High-Grade Gliomas: Single-Center Experience of Six Years in China

Stereotactic and Functional Neurosurgery ◽

10.1159/000509782 ◽

2021 ◽

Vol 99 (3) ◽

pp. 181-186

Author(s):

Ming Zhao ◽

Xiangping Fu ◽

Zhiwen Zhang ◽

Liang Ma ◽

Xiaopeng Wang ◽

...

Keyword(s):

Gamma Knife ◽

Cox Regression ◽

Survival Rates ◽

Gamma Knife Radiosurgery ◽

Progression Free Survival ◽

High Grade Glioma ◽

Karnofsky Performance Score ◽

High Grade ◽

Alternative Treatment Option ◽

The Mean

Objective: The aim of this study was to evaluate the efficacy of Gamma Knife radiosurgery (GKRS) as a salvage therapy for high-grade glioma in our center. Methods: A total of 167 patients with malignant glioma were treated with GKRS in our Gamma Knife Center between January 2013 and December 2017; 140 patients (85 males and 55 females) were followed up and enrolled in our study. A single lesion was found in 110 cases, and multiple lesions were found in 30 cases; 108 cases received a single therapy, and in 32 cases, at least 2 GKRSs were performed. The median tumor volume was 13.5 cm3. The mean radiation dosage was 14.35 Gy (range, 6–18 Gy). MRI was performed regularly. The RANO criteria and Cox analysis were used to evaluate the therapeutic efficiency. Results: Follow-up MRI showed the local control rate was 61.4% at 3 months after GKRS, 25.0% at 6 months, and 7.1% at 12 months. The mean and median progression-free survival (PFS) periods were 8.6 (95% CI, 6.3–11.0) and 4 (95% CI, 3.5–4.5) (range, 1–60) months, respectively. The overall survival (OS) after GKRS was 3–62 months, with a mean of 16.7 (95% CI, 14.6–18.9) months, and the median survival was 13 (95% CI, 12.1–13.9) months. The 1-, 2-, and 5-year survival rates were 51.4, 10.0, and 2.9%, respectively. No severe complications occurred. Cox regression showed that glioma pathology was closely related to prognosis (p < 0.05). The Karnofsky Performance Score had little influence on PFS (p > 0.05) but influenced OS significantly (p < 0.05). Conclusion: GKRS can be used to effectively treat malignant brain glioma and can therefore be used as an alternative treatment option.

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Prognostic Factors in Patients Diagnosed with High Grade Glioma Managed with Radiotherapy: Experience at the Federico Gómez Children's Hospital of Mexico

Gaceta Mexicana de Oncolog�a ◽

10.24875/j.gamo.17000004 ◽

2019 ◽

Vol 16 (1) ◽

Author(s):

María Fátima Chilaca-Rosas ◽

Heynar de Jesús Pérez-Villanueva ◽

Noé Trinidad-Hernández ◽

Juan Carlos Heredia-Gutiérrez ◽

Héctor Urueta-Cuéllar

Keyword(s):

Prognostic Factors ◽

High Grade Glioma ◽

High Grade ◽

Children's Hospital ◽

Children’S Hospital

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Temozolomide in Malignant Gliomas of Childhood: A United Kingdom Children’s Cancer Study Group and French Society for Pediatric Oncology Intergroup Study

Journal of Clinical Oncology ◽

10.1200/jco.2002.08.141 ◽

2002 ◽

Vol 20 (24) ◽

pp. 4684-4691 ◽

Cited By ~ 138

Author(s):

L. S. Lashford ◽

P. Thiesse ◽

A. Jouvet ◽

T. Jaspan ◽

D. Couanet ◽

...

Keyword(s):

Response Rate ◽

Objective Response ◽

Malignant Gliomas ◽

High Grade Glioma ◽

Study Cohort ◽

High Grade ◽

French Society ◽

Significant Treatment ◽

Best Response ◽

Daily Schedule

PURPOSE: To determine the response rate of the malignant gliomas of childhood to an oral, daily schedule of temozolomide. PATIENTS AND METHODS: A multicenter, phase II evaluation of an oral, daily schedule of temozolomide (200 mg/m2 on 5 consecutive days) was undertaken in children with relapsed or progressive, biopsy-proven, high-grade glioma (arm A) and progressive, diffuse, intrinsic brainstem glioma (arm B). Evidence of activity was defined by radiologic evidence of a sustained reduction in tumor size on serial magnetic resonance imaging scans. RESULTS: Fifty-five patients were recruited (34 to arm A and 21 to arm B) and received 215 cycles of chemotherapy. Grade 3/4 thrombocytopenia was the most frequent toxic event (7% of cycles). Prolonged myelosuppression resulted in significant treatment delays and dose reductions (17% and 22% of cycles, respectively). Two toxic deaths were documented and were related to myelosuppression and sepsis in one patient and pneumonia in a second. The overall (best) response rate was 12% for arm A (95% confidence interval [CI], 3 to 28 in the study cohort, and 2 to 31 for eligible patients) and 5% and 6%, respectively, for arm B (95% CI, 0 to 26 in the study cohort, and 0 to 27 for eligible patients). Stabilization of disease was also documented and was most noteworthy for brainstem gliomas, where two patients achieved both radiologic static disease and discontinued steroid medication. CONCLUSION: Despite moderate toxicity, objective response rates to temozolomide have been low, indicating that temozolomide has minimal activity in the high-grade gliomas of childhood.

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EP-1219 Prognostic factors of salvage stereotactic radiotherapy for recurrent high-grade glioma.

Radiotherapy and Oncology ◽

10.1016/s0167-8140(19)31639-1 ◽

2019 ◽

Vol 133 ◽

pp. S673-S674

Author(s):

K. Takehana ◽

M. Uto ◽

K. Ogura ◽

Y. Arakawa ◽

Y. Mineharu ◽

...

Keyword(s):

Prognostic Factors ◽

Stereotactic Radiotherapy ◽

High Grade Glioma ◽

High Grade

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Mindbomb Homolog-1 Index in the Prognosis of High-Grade Glioma and Its Clinicopathological Correlation

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_374_18 ◽

2019 ◽

Vol 10 (02) ◽

pp. 185-193

Author(s):

Shyam Sundar Krishnan ◽

Shanmugam Muthiah ◽

Shilpa Rao ◽

Suganthi Srinivasan Salem ◽

Vasudevan Chakravarthy Madabhushi ◽

...

Keyword(s):

Median Survival ◽

High Grade Glioma ◽

Tumor Grade ◽

Bivariate Analysis ◽

Karnofsky Performance Score ◽

High Grade ◽

Tissue Samples ◽

Midline Crossing ◽

Index Value ◽

Mib 1

ABSTRACT Introduction: Gliomas are the most common brain tumors in adults originating from the glial cells. Glioblastoma multiforme is the most malignant and frequent among all gliomas. In recent years, the antibody Mindbomb Homolog-1 (MIB-1) has evolved as a measure of the proliferative nature of the glial tumors. This study aims to investigate the MIB-1 index value as an independent prognostic factor in high-grade gliomas and its correlation with outcome and survival. Materials and Methods: Mean MIB-1 index was determined in 51 high-grade glioma tissue samples in formalin. Its correlation with outcome by assessing the clinicoradiological parameters and median survival of patients in months were assessed. Survival analysis was studied by using the Kaplan–Meier bivariate analysis and Cox proportional ratio. Results: Preoperative Karnofsky Performance Score, WHO-PS, Neurological Performance Scale, and Mini–Mental Status Examination (MMSE) were statistically significant with respect to outcome and survival, whereas tumor factors such as size and perilesional edema were not. In particular, midline-crossing tumors and deep-seated tumors were significantly associated with high MIB-1 index and by correlation with outcome. There were significantly higher number (P < 0.0001) of patients with Grade IV tumors, with an MIB-1 index value above an arbitrary cutoff of 10% compared to Grade III tumors. In addition, median survival period of patients with low MIB-1 index was longer irrespective of tumor grade. Conclusion: Significant correlation between high-grade glioma and MIB-1 index suggests MIB-1 index to be a good prognostic tool, with MIB-1 index and midline-crossing variables being independent prognostic parameters.

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Advances in Treatment Options for High-grade Glioma - Current Status and Future Perspectives

European Neurological Review ◽

10.17925/enr.2010.05.01.49 ◽

2010 ◽

Vol 5 (1) ◽

pp. 49 ◽

Cited By ~ 1

Author(s):

Ryan T Merrell ◽

Eudocia C Quant ◽

Patrick Y Wen ◽

◽

...

Keyword(s):

Anaplastic Astrocytoma ◽

Brain Tumours ◽

Treatment Options ◽

High Grade Glioma ◽

Current Status ◽

High Grade ◽

Novel Therapies ◽

Targeted Agents ◽

Future Perspectives ◽

Primary Brain Tumours

High-grade gliomas, including glioblastoma, anaplastic astrocytoma, anaplatic oligodendroglioma and anaplastic oligoastrocytoma, account for the majority of malignant primary brain tumours diagnosed in adults. The prognosis for these tumours is poor despite multimodality therapy with surgery, radiation and/or chemotherapy. This review summarises treatment options for high-grade glioma, including standard regimens, targeted agents and novel therapies.

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Advances in Treatment Options for High-grade Glioma—Current Status and Future Perspectives

US Neurology ◽

10.17925/usn.2010.06.01.55 ◽

2010 ◽

Vol 06 (01) ◽

pp. 55 ◽

Cited By ~ 1

Author(s):

Ryan T Merrell ◽

Eudocia C Quant ◽

Patrick Y Wen ◽

◽

...

Keyword(s):

Brain Tumors ◽

Anaplastic Astrocytoma ◽

Treatment Options ◽

High Grade Glioma ◽

Multimodality Therapy ◽

Current Status ◽

High Grade ◽

Novel Therapies ◽

Targeted Agents ◽

Future Perspectives

High-grade gliomas, including glioblastoma, anaplastic astrocytoma, anaplatic oligodendroglioma, and anaplastic oligoastrocytoma, account for the majority of malignant primary brain tumors diagnosed in adults. The prognosis for these tumors is poor despite multimodality therapy with surgery, radiation, and/or chemotherapy. This article summarizes treatment options for high-grade glioma, including standard regimens, targeted agents, and novel therapies.

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