Published online May 10, 2014. doi: 10.5306/wjco.v5.i2.142
Revised: March 27, 2014
Accepted: April 16, 2014
Published online: May 10, 2014
Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor with a survival prognosis of 14-16 mo for the highest functioning patients. Despite aggressive, multimodal upfront therapies, the majority of GBMs will recur in approximately six months. Salvage therapy options for recurrent GBM (rGBM) are an area of intense research. This study compares recent survival and quality of life outcomes following Gamma Knife radiosurgery (GKRS) salvage therapy. Following a PubMed search for studies using GKRS as salvage therapy for malignant gliomas, nine articles from 2005 to July 2013 were identified which evaluated rGBM treatment. In this review, we compare Overall survival following diagnosis, Overall survival following salvage treatment, Progression-free survival, Time to recurrence, Local tumor control, and adverse radiation effects. This report discusses results for rGBM patient populations alone, not for mixed populations with other tumor histology grades. All nine studies reported median overall survival rates (from diagnosis, range: 16.7-33.2 mo; from salvage, range: 9-17.9 mo). Three studies identified median progression-free survival (range: 4.6-14.9 mo). Two showed median time to recurrence of GBM. Two discussed local tumor control. Six studies reported adverse radiation effects (range: 0%-46% of patients). The greatest survival advantages were seen in patients who received GKRS salvage along with other treatments, like resection or bevacizumab, suggesting that appropriately tailored multimodal therapy should be considered with each rGBM patient. However, there needs to be a randomized clinical trial to test GKRS for rGBM before the possibility of selection bias can be dismissed.
Core tip: Glioblastoma is the most common malignant primary neoplasm of the brain. Despite aggressive, upfront therapy, most patients will experience a recurrence of their tumor six months after treatment. This review article analyzes the outcomes of clinical trials that utilized Gamma Knife radiosurgery as salvage therapy for recurrent glioblastoma. Other modalities of radiosurgery were excluded from this study as there is variability in the targeting precision and radiation dosage fall off. Gamma Knife can be used to target tumors that are adjacent to eloquent brain tissue, thus allowing it to treat a wider population of patients, improving overall survival.