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  • The role of stereotactic radiosurgery and its combination with temozolomide as a salvage treatment of recurrent glioblastoma

    Final Number:

    Kyunghwan Kim MD; Jung-Il Lee MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: There is no standard for salvage treatment in patients with recurrent glioblastoma multiforme (GBM). The gamma-knife stereotactic radiosurgery (GKS) is a candidate for effective modality in the second-line treatment, but its role and benefit for recurrent GBM are controversial. This study is a retrospective review of our institutional experience in the treatment of recurrent GBM and we investigate the role of the GKS and its application as the salvage treatment.

    Methods: Between January 2002 and December 2011, a total of 222 patients developed recurrent GBM after initial surgery and radiotherapy with concomitant temozolomide (TMZ). Among them, 144 patients received various salvage treatments. We divided them into 5 groups; combination of radiosurgery and temozolomide (group 1, n = 28), GKS alone (group 2, n = 29), TMZ alone (group 3, n = 31), re-operation and adjuvant therapy (group 4, n = 38), and other chemo- or radiotherapy (group 5, n = 18). We compared the efficacy of each treatment modality.

    Results: The median overall survival (OS) from the time of progression was 12.2, 9.2 and 6.0 months for patients in group 1 through 3, respectively (p=0.04). The median progression free survival (PFS) from the first progression was 6.6, 3.6, and 2.3 months for patients in group 1 through 3, respectively (p=0.02). In the multivariate analysis, the performance status and the time to progression were independent prognostic factors. The OS and PFS in re-operation group were 13.2 and 4.2 respectively.

    Conclusions: The GKS with concomitant TMZ attained survival advantage in the treatment of recurrent GBM in comparison with GKS alone or TMZ alone. Survival outcome of radiosurgery was compatible with re-operation in the salvage situation. To treat recurrent GBM, both local and systemic modalities are important as like in initial treatment. Combination with GKS and systemic TMZ is a good strategy for managing recurrent GBM.

    Patient Care: this research may recommend a good treatment option for patients with recurrent malignant glioma.

    Learning Objectives: By the conclusion of this session, participants should be able to : Identify an effective combination of local (stereotactic radiosurgery) and systemic (temozolomide chemotherapy) treatments for managing recurrent glioblastoma


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