Management of glioblastoma after recurrence: A changing paradigm.
AIM To describe the clinical results a prospective phase II study of radiosurgically treated patients with recurrent glioblastoma multiforme. PATIENTS AND METHOD Since 1986, 62 patients were irradiated stereotactically. Including criteria were residual tumor < or = 5 cm and Karnofsky performance score > or = 70. Twenty-seven patients (mean age 50 years) were treated for recurrent tumor. The planning target volume was defined by the contrast enhancing region demonstrated by magnetic resonance imaging (MRI) scans which were performed in treatment position. A safety margin of 2 to 5 mm was added. The mean dose was 17 Gy. The median interval from the time of initial diagnosis and therapy to radiosurgery for recurrent tumor was 9.6 months. Initial therapy consisted of surgery and irradiation (60 Gy). Survival curves were calculated according to the Kaplan Meier method. Quality of life was evaluated using objective criteria such as neurological findings, frequency of seizures and steroid medication. RESULTS The median survival calculated from the time of diagnosis was 18 months, calculated from the time of radiosurgery 9 months. 4.5 months after therapy, 50% of the patients showed improved or stable quality of life. CONCLUSION Radiosurgery demonstrates efficacy in selected patients suffering from recurrent glioblastoma multiforme.