19 juli 2012: Hypofractionated stereotactic radiation therapy: an effective therapy for recurrent high-grade gliomas volledig studie rapport uit 2010 toegevoegd onderaan artikel plus referentielijst van aan onderwerp gerelateerde studies. 

Radiother Oncol. 2003 May;67(2):183-90.

Fractionele stereotactische bestraling na een normale post-operatieve bestralingsperiode geeft bij voorgeselecteerde patiënten met een hoog kwaadaardige hersentumor - glioma type - een significant betere en langere overleving in vergelijking wat mocht worden verwacht op basis van historische gegevens bij vergelijkbare groep patiënten. Hier zo goed als letterlijk vertaald de resultaten uit deze studie:

RESULTATEN: Alle patiënten werden behandeld met conventionele raduiotherapie een een SRT = stereotactische extra dosis (15 patiënten ontvingen 20 Gy en twee patiënten 10 Gy). Acute bijwerkingen waren moeheid (twee), verstoring van het korte termijn geheugen (een) en verergering van al bestaande symptomen (een). Geen enkele patiënt ontwikkelde stereoide afhankelijkheid na de SRT. Een patient werd opnieuw geopereerd voor necrotisch weefsel veroorzaakt door de bestraling. Binnen een mediane follow-up van 25 maanden (9-50 maanden) kregen 14 patiënten een lokaal recidief. 1 jaars overleving was 77% en 2 jaars overleving 42%; Porgressievrije - ziektevrije tijd was 70% na 1 jaar en 35% na 2 jaar voor alle patiënten. Mediane overleving is voor de hele patiëntengroep 20 maanden. Vergelijking met een historisch vergelijkbare groep toonde deze studie een significant betere overleving voor de groep behandeld met een extra dosis stereotactische bestraling. (P<0.0001).

Fractionated stereotactic radiotherapy boost after post-operative radiotherapy in patients with high-grade gliomas. Baumert BG, Lutterbach J, Bernays R, Davis JB, Heppner FL. Radiation-Oncology, University Hospital Zurich, Zurich, Switzerland. PURPOSE: To determine the value and the toxicity of an additional fractionated stereotactic boost as used in the joint randomized EORTC-22972/MRC-BR10 study in patients with malignant gliomas.

MATERIALS AND METHODS: Seventeen patients (11 male, six female) with a high-grade glioma (two WHO III, 15 WHO IV) < or =4 cm in maximum diameter, with a good performance status (WHO > or =2), were treated with a fractionated stereotactic radiotherapy (SRT) boost to 20 Gy in four fractions following partial brain irradiation to a dose of 60 Gy in 30 fractions. This patient group was compared with historical data in a matched-pair analysis.

RESULTS: All patients were treated by conventional radiotherapy and a SRT boost (15 patients received 20 Gy and two patients 10 Gy). Acute side effects included fatigue (two), impairment of short-term memory (one) and worsening of pre-existing symptoms (one). No patient developed steroid dependence after SRT. One patient was re-operated for radiation necrosis. At a median follow-up of 25 months (9-50 months) 14 patients recurred locally. Survival was 77% at 1 year and 42% at 2 years; progression-free survival was 70% at 1 year and 35% at 2 years for all patients, respectively. Median survival for the whole patient group is 20 months. Comparison with a matched historical group showed a significantly better survival for the group treated with a stereotactic boost (P<0.0001).

CONCLUSION: A fractionated stereotactic boost after standard external beam radiotherapy in selected patients with high-grade glioma is feasible and well tolerated with low toxicity. Compared to historical data survival is significantly better with an additional SRT boost. However, its effectiveness has to be proven in a randomized trial.

PMID: 12812849 [PubMed - indexed for MEDLINE]

Hypofractionated stereotactic radiation therapy: an effective therapy for recurrent high-grade gliomas

Hypofractionated stereotactic radiation therapy: an effective therapy for recurrent high-grade gliomas.


Department of Radiation Oncology, Neurological Surgery, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA. Shannon.fogh@jeffersonhospital.org

Erratum in

  • J Clin Oncol. 2010 Sep 20;28(27):4280.



Salvage options for recurrent high-grade gliomas (HGGs) are limited by cumulative toxicity and limited efficacy despite advances in chemotherapeutic and radiotherapeutic techniques. Previous studies have reported encouraging survival results and favorable toxicity with fractionated stereotactic radiotherapy, and small studies have shown similar benefit using a shortened course of hypofractionated stereotactic radiation therapy (H-SRT). We sought to determine the efficacy and toxicity profile of H-SRT alone or in addition to repeat craniotomy or concomitant chemotherapy.


Between 1994 and 2008, 147 patients with recurrent HGG were treated with H-SRT (median dose, 35 Gy in 3.5-Gy fractions). Cox regression models were used to analyze survival outcomes. Variables included age, surgery before H-SRT, time to first recurrence, reirradiation dose, inclusion of chemotherapy with H-SRT, and gross tumor volume (GTV).


Younger age (P = .001), smaller GTV (P = .025), and shorter time between diagnosis and recurrence (P = .034) were associated with improvement in survival from H-SRT. Doses of radiation > or = 35 Gy approached significance (P = .07). There was no significant benefit of surgical resection or chemotherapy in this population when analysis was controlled for other prognostic factors.


H-SRT was well tolerated and resulted in a median survival time of 11 months after H-SRT, independent of re-operation or concomitant chemotherapy. Patients who experienced recurrence within 6 months after initial treatment had an excellent response and should not be disqualified from H-SRT. This is the largest series to examine the efficacy and tolerability of H-SRT in recurrent HGG.

Comment in

[PubMed - indexed for MEDLINE]


1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006;56:106–130. [PubMed]
2. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987–996. [PubMed]
3. Curran WJ, Jr, Scott CB, Horton J, et al. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst. 1993;85:704–710. [PubMed]
4. Wallner KE, Galicich JH, Krol G, et al. Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys. 1989;16:1405–1409. [PubMed]
5. Bernstein M, Laperriere N, Glen J, et al. Brachytherapy for recurrent malignant astrocytoma. Int J Radiat Oncol Biol Phys. 1994;30:1213–1217. [PubMed]
6. Chamberlain MC, Barba D, Kormanik P, et al. Stereotactic radiosurgery for recurrent gliomas. Cancer. 1994;74:1342–1347. [PubMed]
7. Gutin PH, Prados MD, Phillips TL, et al. External irradiation followed by an interstitial high activity iodine-125 implant “boost” in the initial treatment of malignant gliomas: NCOG study 6G-82-2. Int J Radiat Oncol Biol Phys. 1991;21:601–606. [PubMed]
8. Hall WA, Djalilian HR, Sperduto PW, et al. Stereotactic radiosurgery for recurrent malignant gliomas. J Clin Oncol. 1995;13:1642–1648. [PubMed]
9. Leibel SA, Gutin PH, Wara WM, et al. Survival and quality of life after interstitial implantation of removable high-activity iodine-125 sources for the treatment of patients with recurrent malignant gliomas. Int J Radiat Oncol Biol Phys. 1989;17:1129–1139. [PubMed]
10. Mehta MP, Masciopinto J, Rozental J, et al. Stereotactic radiosurgery for glioblastoma multiforme: Report of a prospective study evaluating prognostic factors and analyzing long-term survival advantage. Int J Radiat Oncol Biol Phys. 1994;30:541–549. [PubMed]
11. Scharfen CO, Sneed PK, Wara WM, et al. High activity iodine-125 interstitial implant for gliomas. Int J Radiat Oncol Biol Phys. 1992;24:583–591. [PubMed]
12. Shrieve DC, Alexander E, 3rd, Wen PY, et al. Comparison of stereotactic radiosurgery and brachytherapy in the treatment of recurrent glioblastoma multiforme. Neurosurgery. 1995;36:275–282. discussion 282-284. [PubMed]
13. Corn BW, Curran WJ, Jr, Shrieve DC, et al. Stereotactic radiosurgery and radiotherapy: New developments and new directions. Semin Oncol. 1997;24:707–714. [PubMed]
14. Macdonald DR, Cascino TL, Schold SC, Jr, et al. Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol. 1990;8:1277–1280. [PubMed]
15. Gill SS, Thomas DG, Warrington AP, et al. Relocatable frame for stereotactic external beam radiotherapy. Int J Radiat Oncol Biol Phys. 1991;20:599–603. [PubMed]
16. Carson KA, Grossman SA, Fisher JD, et al. Prognostic factors for survival in adult patients with recurrent glioma enrolled onto the new approaches to brain tumor therapy CNS consortium phase I and II clinical trials. J Clin Oncol. 2007;25:2601–2606. [PubMed]
17. Wong ET, Hess KR, Gleason MJ, et al. Outcomes and prognostic factors in recurrent glioma patients enrolled onto phase II clinical trials. J Clin Oncol. 1999;17:2572–2578. [PubMed]
18. Vredenburgh JJ, Desjardins A, Herndon JE, 2nd, et al. Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol. 2007;25:4722–4729. [PubMed]
19. Combs SE, Thilmann C, Edler L, et al. Efficacy of fractionated stereotactic reirradiation in recurrent gliomas: Long-term results in 172 patients treated in a single institution. J Clin Oncol. 2005;23:8863–8869. [PubMed]
20. Combs SE, Gutwein S, Schulz-Ertner D, et al. Temozolomide combined with irradiation as postoperative treatment of primary glioblastoma multiforme: Phase I/II study. Strahlenther Onkol. 2005;181:372–377. [PubMed]
21. Lederman G, Wronski M, Arbit E, et al. Treatment of recurrent glioblastoma multiforme using fractionated stereotactic radiosurgery and concurrent paclitaxel. Am J Clin Oncol. 2000;23:155–159. [PubMed]
22. Arcicasa M, Roncadin M, Bidoli E, et al. Reirradiation and lomustine in patients with relapsed high-grade gliomas. Int J Radiat Oncol Biol Phys. 1999;43:789–793. [PubMed]
23. Glass J, Silverman CL, Axelrod R, et al. Fractionated stereotactic radiotherapy with cis-platinum radiosensitization in the treatment of recurrent, progressive, or persistent malignant astrocytoma. Am J Clin Oncol. 1997;20:226–229. [PubMed]
24. Combs SE, Bischof M, Welzel T, et al. Radiochemotherapy with temozolomide as re-irradiation using high precision fractionated stereotactic radiotherapy (FSRT) in patients with recurrent gliomas. J Neurooncol. 2008;89:205–210. [PubMed]
25. Larson DA, Prados M, Lamborn KR, et al. Phase II study of high central dose Gamma Knife radiosurgery and marimastat in patients with recurrent malignant glioma. Int J Radiat Oncol Biol Phys. 2002;54:1397–1404. [PubMed]
26. Schäfer U, Micke O, Schuller P, et al. The effect of sequential radiochemotherapy in preirradiated malignant gliomas in a phase II study. J Neurooncol. 2004;67:233–239. [PubMed]
27. Schönekaes K, Mucke R, Panke J, et al. Combined radiotherapy and temozolomide in patients with recurrent high grade glioma. Tumori. 2002;88:28–31. [PubMed]
28. VanderSpek L, Fisher B, Bauman G, et al. 3D conformal radiotherapy and cisplatin for recurrent malignant glioma. Can J Neurol Sci. 2008;35:57–64. [PubMed]
29. Hudes RS, Corn BW, Werner-Wasik M, et al. A phase I dose escalation study of hypofractionated stereotactic radiotherapy as salvage therapy for persistent or recurrent malignant glioma. Int J Radiat Oncol Biol Phys. 1999;43:293–298. [PubMed]
30. Shepherd SF, Laing RW, Cosgrove VP, et al. Hypofractionated stereotactic radiotherapy in the management of recurrent glioma. Int J Radiat Oncol Biol Phys. 1997;37:393–398. [PubMed]
31. Laing RW, Warrington AP, Graham J, et al. Efficacy and toxicity of fractionated stereotactic radiotherapy in the treatment of recurrent gliomas (phase I/II study) Radiother Oncol. 1993;27:22–29. [PubMed]
32. Florell RC, Macdonald DR, Irish WD, et al. Selection bias, survival, and brachytherapy for glioma. J Neurosurg. 1992;76:179–183. [PubMed]
33. Lederman G, Arbit E, Odaimi M, et al. Fractionated stereotactic radiosurgery and concurrent taxol in recurrent glioblastoma multiforme: A preliminary report. Int J Radiat Oncol Biol Phys. 1998;40:661–666. [PubMed]
34. Alexander E, 3rd, Loeffler JS. Radiosurgery using a modified linear accelerator. Neurosurg Clin N Am. 1992;3:167–190. [PubMed]
35. Kim HK, Thornton AF, Greenberg HS, et al. Results of re-irradiation of primary intracranial neoplasms with three-dimensional conformal therapy. Am J Clin Oncol. 1997;20:358–363. [PubMed]
36. Cho KH, Hall WA, Gerbi BJ, et al. Single dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas. Int J Radiat Oncol Biol Phys. 1999;45:1133–1141. [PubMed]
37. Schwer AL, Damek DM, Kavanagh BD, et al. A phase I dose-escalation study of fractionated stereotactic radiosurgery in combination with gefitinib in patients with recurrent malignant gliomas. Int J Radiat Oncol Biol Phys. 2008;70:993–1001. [PubMed]
38. Grosu AL, Weber WA, Franz M, et al. Reirradiation of recurrent high-grade gliomas using amino acid PET (SPECT)/CT/MRI image fusion to determine gross tumor volume for stereotactic fractionated radiotherapy. Int J Radiat Oncol Biol Phys. 2005;63:511–519. [PubMed]
39. Mayer R, Sminia P. Reirradiation tolerance of the human brain. Int J Radiat Oncol Biol Phys. 2008;70:1350–1360. [PubMed]

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