Stereotactic Irradiation of Low-grade Glioma Using a Leksell Gamma Knife

Czech version

Authors: G. Šimonová ¹; J. Šemnická ²; R. Liščák ¹
Authors‘ workplace: Nemocnice Na Homolce, Praha Odd. stereotaktické a radiační neurochirurgie ¹; Nemocnice Na Homolce, Praha Odd. lékařské fyziky ²
Published in: Cesk Slov Neurol N 2011; 74/107(3): 312-319
Category: Original Paper

Overview

Objective:
To evaluate treatment results, radiation-related toxicity and prognostic factors for progression free survival (PFS) in patients with low-grade glioma irradiated by Leksell Gamma Knife.

Materials and methods:
A total of 88 patients underwent hypofractionated stereotactic irradiation to treat low-grade glioma. The median minimum applied dose to the planning target volume (PTV) was 25 Gy (12–35). The dosage was prescribed with respect to the several conditions: number of fractions, previous irradiation, planning target volume and age. The radiation toxicity and severity of symptoms (neurological functional class [NFC]) were evaluated according to the RTOG/EORTC system. We analyzed variables affecting progression-free survival (PFS) after treatment and radiation-induced late toxicity (grade, age, volume, biologically effective dose, previous radiotherapy, NFC score before treatment). We used univariate analysis (Kaplan-Meier with log-rank test) and multivariate analysis (Cox regression) to detect differences in survival curves, as well as correlation analysis to detect variables associated with toxicity.

Results:
10-year PFS was 78%. As expected, we found a greater surviving proportion among grade I patients, (91% surviving at 5 years, 88% at 10 years) than grade II patients (79% surviving at 5 years, 67% at 10 years), p = 0.010 log-rank, p = 0.025 Cox. Among the other variables we detected as significant positive prognostic factors: age < 30 years (p = 0.044 log-rank), BED 85–110 Gy, which is an intermediate category, (p = 0.019 log-rank), and not previously irradiated (p = 0.032 log-rank, p = 0.075 Cox). In our group of patients we observed grade 3 late toxicity in 10% of cases. Among the variables analyzed we found none associated with incidence of toxicity.

Conclusion:
Radiosurgery is a treatment modality for small residual or reoccurrence volumes of low-grade glioma with relatively long-term local control.

Key words:
glioma –⁠ Leksell gamma knife –⁠ prognosis

Sources

1. Knisely JP, Lally BE. Validation of the European Organization for Research and Treatment of Cancer (EORTC) Prognostic factors for Low grade Gliomas Utilizing the Surveillance, Epidemiology and End results database. Int J Radiat Oncol Biol Phys 2005; 63 (Suppl 1): 262–263.

2. Shaw E, Arusell R, Scheithauer J, Fallon B, O’Neill R, Dinapoli D et al. Prospective randomize trial of low-versus high dose radiation therapy in adults with supratentorial low-grade glioma: initial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study. J Clin Oncol 2002; 20(9): 2267–2276.

3. Karim AB, Maat B, Hatlevoll, Menten J, Rutten EH, Thomas DG et al. A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma:EORTC study 22844. Int J Radiat Oncol Biol Phys 1996; 36 : 549–556.

4. Karim ABMF, Afra D, Cornu P, Bleehan N, Schraub S, De Witte O et al. Randomized trial on the efficacy of radiotherapy for cerebral low-grade gliom in the adult: EORTC Study 2285 with the MRC Study BR04: An interim analysis. Int J Radiat Oncol Biol Phys 2002; 52(2): 316–324.

5. Bauman G, Lote K, Larson D, Stalpers L, Leighton Ch, Fisher B et al. Pretreatment factors predict overall surviving for patients with low-grade glioma: a recursive partitioning analysis. Int J Radiat Oncol Biol Phys1999; 45(4): 923–929.

6. Plathow C, Schulz-Ertner D, Thilman Ch, Zuna I, Lichy M, Weber M-A et al. Fractionated stereotactic radiotherapy in low-grade astrocytomas: long-term outcome and prognostic factors. Int J Radiat Oncol Biol Phys 2003, 57(4): 996–1003.

7. Simonová G, Novotná J jr, Liscak R. Low-grade gliomas treated by fractionated gamma knife surgery. J Neurosurg 2005; 10 (Suppl): 19–24.

8. Choucair AK, Scott C, Urtasun R, Nelson D, Mousas B, Curran W. Quality of life and neuropsychological evaluation for patients with malignant astrocytomas:RTOG 91-14. Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 1997; 38(1): 9–20.

9. Kano H, Kondziolka D, Niranjan A, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for pilocytic astrocytomas part 1: outcomes in adult patients. J Neurooncol 2009; 95(2): 211–218.

10. Kano H, Niranjan A, Kondziolka D, Flickinger JC, Pollack IF, Jakacki RI et al. Stereotactic radiosurgery for pilocytic astrocytomas part 2: outcomes in pediatric patients. J Neurooncol 2009; 95(2): 219–229.

11. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31(5):1341–1346.

12. Hall EJ. Radiobiology for the radiologist. 5th ed. New York: Lippincott Williams Wilkins 2000 : 397–416.

13. Steel GG. Basic Clinical Radiobiology. 3rd ed. London: Hodeer Arnold 2002 : 135–149.

14. Pollock BE, Brown RD jr. Management of cysts arising after radiosurgery for cerebral arteriovenous malformation. Neurosurgery 2001; 49(2): 259–264

15. Hara M, Nakamura M, Shiokawa Y, Sawa H, Sato E, Koyasu H et al. Delayed cyst formation after radiosurgery for cerebral arteriovenous malformation: two case reports. Minim Invasive Neurosurg 1998, 41(1): 40–45.

16. Yamamoto M, Ide M, Jimbo M, Mitsuhiro H, Saito I, Mori K. Gamma knife radiosurgery for arteriovenous malformations: long-term follow up results focusing on complications occoring more than 5 years after irradiation. Neurosurg 1996, 38(5): 906–914.

17. Kim MS, Lee SI, Sim JH. A case of very large cyst formation with gamma knife radiosurgery for an arteriovenous malformation. Stereotactic Funct Neurosurg 1999; 72 (Suppl 1): 168–174.

18. Kihlström L, Hindmarsh T, Lax I, Lippitz B, Mindus P, Lindquist C. Radiosurgical lesions in the normal human brain 17 years after gamma knife capsulotomy. Neurosurg 1997; 41(2): 396–402.

19. Wallren KE, Gonzales MF, Edwards MS, Wara WM, Sheline GE. Treatment results of juvenile pilocytic astrocytoma. J Neurosurg 1988; 69(2): 171–176.

20. Šimonová G, Novotný HJ jr. Stereotaktická radiochirurgie a radoterapie. In: Šlampa, P, Petera, J et al (eds). Radiační onkologie. Praha: Galén 2007 : 418–420.

21. Sgouros S, Fineron PW, Hockley AD. Cerebellar astrocytoma in childhood: long-term follow up. Childs Nerv Syst 1995; 11(2): 89–96.

22. Kidd EA, Mansur DB, Leonard JR, Michalski JM, Simpson JR. The efficacy of radiation therapy in the management of grade I astrocytomas. J Neurooncol 2006; 76(1): 55–58.

23. Saran FH, Baumert BG, Khoo VS, Adams EJ, Garré ML, Warrington AP et al. Stereotactically guided conformal radiotherapy for progressive low-grade gliomas of childhood. Int J Radiat Oncol Biol Phys 2002; 53(1): 43–51.

24. Marcus KJ, Goumnerova L, Billett AL, Lavally B, Scott M, Bishop K et al. Stereotactic radiotherapy for localized low-grade gliomas in children: Final results of a prospective trial. Int J Radiat Oncol Biol Phys 2005; 61(2): 374–379.

25. Bauman G, Fisher B, Watling Ch, Caimcross JG, MacDonald D Adult supratentorial low-grade glioma: long-term experience at a single institution. Int J Radiat Oncol Biol Phys 2009; 75(2): 1401–1407.

26. Ruiz J, Lesser GJ. Low-grade gliomas. Curr Treat Options 2009; 10(3–4): 231–242.