Journal of Clinical Oncology, Vol 10, 1379-1385, Copyright © 1992 by American Society of Clinical Oncology
Radiosurgery as part of the initial management of patients with malignant gliomas
JS Loeffler, E Alexander 3d, WM Shea, PY Wen, HA Fine, HM Kooy and PM Black
Brain Tumor Center, Brigham and Women's Hospital, Boston, MA.
PURPOSE: Between May 1988 and May 1991, 41 patients with malignant gliomas
were enrolled onto a prospective study designed to evaluate the role of
radiosurgery as a component of initial management. PATIENTS AND METHODS:
Thirty-seven patients underwent radiosurgery according to the protocol and
were assessable for survival and complications of treatment. Diagnoses
included glioblastoma multiforme (GBM) in 23 (62%) cases and anaplastic
astrocytoma in 14 (38%) cases. In 20 (54%) cases, surgical resection was
attempted initially, whereas 17 (46%) patients underwent biopsy only.
Patients in the study group received external- beam radiotherapy that
consisted of 5,940 cGy given in 33 fractions to partial brain fields that
encompassed the primary tumor with a 3 to 4 cm margin. Radiosurgery, used
as a technique for boosting the dose to any residual contrast-enhancing
mass lesion, was given 2 to 4 weeks after the completion of conventional
radiotherapy. Minimum radiosurgical doses ranged from 1,000 to 2,000 cGy
(median, 1,200 cGy), whereas maximum doses ranged from 1,250 to 2,500 cGy
(median, 1,500 cGy). The median tumor volume at the time of radiosurgery
was 4.8 cm3 (range, 1.2 to 72 cm3). Adjuvant chemotherapy was not given.
RESULTS: After a median follow-up of 19 months, only nine of 37 (24%)
patients have died. Six patients (all glioblastoma multiforme) died of
recurrent tumor, whereas death was attributable to complications of
treatment in two cases and intercurrent disease in one case. Four patients
with recurrent tumor failed at the margins of the radiosurgical treatment
volume, whereas two patients progressed locally. One patient is alive with
local and marginal failure. Seven (19%) patients underwent reoperation at a
median time of 5 months (range, 1 to 14 months) after radiosurgery.
CONCLUSION: We conclude that radiosurgery is a useful adjunct to other
modalities in the initial management of patients with small,
radiographically well-defined malignant gliomas.
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