Safety and efficacy of hypofractionated stereotactic radiosurgery with anlotinib targeted therapy for glioblastoma at first recurrence: A preliminary report.

e14015 Background: The optimal treatment for recurrent glioblastoma (rGBM) remains uncertain. Hypofractionated stereotactic radiotherapy (HSRT) and anti-vascular endothelial growth factor (VEGF) antibodies (e.g, bevacizumab and anlotinib) have been reported a promising survival benefit and acceptable toxicity in recent studies. This research aimed to investigate the efficacy and safety of hypofractionated stereotactic radiosurgery with anlotinib as a salvage treatment for rGBM within the radiation field at first recurrence. Methods: Between December 2019 and June 2020, rGBM patients treated with CyberKnife (CK) radiosurgery concurrently with anlotinib were retrospectively analyzed. Anlotinib was prescribed 12 mg daily during CK. Adjuvant anlotinib was administered 12mg d1-14 every 3 weeks. The primary endpoint was objective response rate (ORR) using response assessment in neuro-oncology (RANO) criteria, and secondary endpoints included overall survival (OS), progression-free survival (PFS) after salvage treatment, and toxicity. Toxicity was assessed using common terminology criteria for adverse events (CTCAE) 5.0. Results: A total of five patients were included in the study. The median planning target volume (PTV) was 26.94 cm3 (5.53 to 54.41 cm3). The prescribed dose was 25.0 Gy in 5 fractions. The median number of cycles of anlotinib was 9 (4 to 15 cycles). The median baseline Karnofsky Performance Status (KPS) is 80 (70 to 90). The follow-up ranged from 4 to 10 months. Three (60%) patients had the best outcome of partial response (PR), and 2 (40%) achieved complete response (CR), the ORR was 100%. No patient died or had progressive disease (PD) until the last follow-up. Two patients had grade 2 hand-foot syndrome and relieved after dermatology treatments, no other grade 3 or higher toxicities was recorded. Conclusions: Salvage radiosurgery with anlotinib showed a favorable outcome and acceptable toxicity for rGBM patients in this preliminary report. A prospective phase II study (NCT04197492) is ongoing to further investigate the regimen in rHGG. [Table: see text]

Cyberknife® hypofractionated stereotactic radiosurgery (CK-hSRS) as salvage treatment for brain metastases

Purpose The introduction of hypofractionated stereotactic radiosurgery (hSRS) extended the treatment modalities beyond the well-established single-fraction stereotactic radiosurgery and fractionated radiotherapy. Here, we report the efficacy and side effects of hSRS using Cyberknife® (CK-hSRS) for the treatment of patients with critical brain metastases (BM) and a very poor prognosis. We discuss our experience in light of current literature. Methods All patients who underwent CK-hSRS over 3 years were retrospectively included. We applied a surface dose of 27 Gy in 3 fractions. Rates of local control (LC), systemic progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier method. Treatment-related complications were rated using the Common Terminology Criteria for Adverse Events (CTCAE). Results We analyzed 34 patients with 75 BM. 53% of the patients had a large tumor, tumor location was eloquent in 32%, and deep seated in 15%. 36% of tumors were recurrent after previous irradiation. The median Karnofsky Performance Status was 65%. The actuarial rates of LC at 3, 6, and 12 months were 98%, 98%, and 78.6%, respectively. Three, 6, and 12 months PFS was 38%, 32%, and 15%, and OS was 65%, 47%, and 28%, respectively. Median OS was significantly associated with higher KPS, which was the only significant factor for survival. Complications CTCAE grade 1–3 were observed in 12%. Conclusion Our radiation schedule showed a reasonable treatment effectiveness and tolerance. Representing an optimal salvage treatment for critical BM in patients with a very poor prognosis and clinical performance state, CK-hSRS may close the gap between surgery, stereotactic radiosurgery, conventional radiotherapy, and palliative care.

Safety and efficacy of Hypofractionated stereotactic radiosurgery for high-grade Gliomas at first recurrence: a single-center experience

Background The optimal treatment for recurrent high-grade gliomas (rHGGs) remains uncertain. This study aimed to investigate the efficacy and safety of hypofractionated stereotactic radiosurgery (HSRS) as a first-line salvage treatment for in-field recurrence of high-grade gliomas. Methods Between January 2016 and October 2019, 70 patients with rHGG who underwent HSRS were retrospectively analysed. The primary endpoint was overall survival (OS), and secondary endpoints included both progression-free survival (PFS) and adverse events, which were assessed according to Common Toxicity Criteria Adverse Events (CTCAE) version 5. The prognostic value of key clinical features (age, performance status, planning target volume, dose, use of bevacizumab) was evaluated. Results A total of 70 patients were included in the study. Forty patients were male and 30 were female. Forty-nine had an initial diagnosis of glioblastoma (GBM), and the rest (21) were confirmed to be WHO grade 3 gliomas. The median planning target volume (PTV) was 16.68 cm3 (0.81–121.96 cm3). The median prescribed dose was 24 Gy (12–30 Gy) in 4 fractions (2–6 fractions). The median baseline of Karnofsky Performance Status (KPS) was 70 (40–90). With a median follow-up of 12.1 months, the median overall survival after salvage treatment was 17.6 months (19.5 and 14.6 months for grade 3 and 4 gliomas, respectively; p = .039). No grade 3 or higher toxicities was recorded. Multivariate analysis showed that concurrent bevacizumab with radiosurgery and KPS > 70 were favourable prognostic factors for grade 4 patients with HGG. Conclusions Salvage HSRS showed a favourable outcome and acceptable toxicity for rHGG. A prospective phase II study (NCT04197492) is ongoing to further investigate the value of hypofractionated stereotactic radiosurgery (HSRS) in rHGG.

Safety and Efficacy of Hypofractionated Stereotactic Radiosurgery for High-Grade Gliomas at First Recurrence: A Single-Center Experience

Background: The optimal treatment for recurrent high-grade gliomas (rHGG) remains uncertain. This study aimed to investigate the efficacy and safety of CyberKnife radiosurgery as a salvage treatment for in field recurrence of high-grade gliomas at first time.Methods: Between January 2016 and October 2019, seventy patients with rHGG undergone CyberKnife radiosurgery were retrospectively analyzed. The primary endpoint was overall survival (OS), and secondary endpoints included both progression-free survival (PFS) and adverse events which was according to Common Toxicity Criteria Adverse Events (CTCAE) version 5. The prognostic value of key clinical features (age, performance status, planning target volume, dose, use of bevacizumab) were evaluated.Results: A total of 70 patients were included in the study. Forty patients were male and 30 were female. Forty-nine had an initial diagnosis of glioblastoma (GBM), and the rest (21) were confirmed to be WHO grade 3 gliomas. The median planning target volume (PTV) was 16.68 cm3 (0.81 – 121.96 cm3). The median prescribed dose was 24 Gy (12-30 Gy) in 4 fractions (2-6 fractions). Median baseline of Karnofsky Performance Status (KPS) is 70 (40 - 90). With a median follow-up of 12.1 months, the median overall survival after salvage treatment was 17.6 months (19.5 and 14.6 months for grade 3 and 4 gliomas respectively; p = .039). No grade 3 or higher toxicities was recorded. Multivariate analysis showed that concurrent bevacizumab with radiosurgery and KPS>70 were favorable prognostic factors for grade 4 patients with HGG.Conclusions: Salvage CyberKnife radiosurgery showed a favorable outcome and acceptable toxicity for rHGG. A prospective phase II study (NCT04197492) is ongoing to further investigate the value of hypofractionated stereotactic radiosurgery (HSRS) in rHGG.