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Gamma Knife Radiosurgery for High Grade Glial Neoplasms: A Canadian Experience

Published online by Cambridge University Press:  23 September 2014

F.A. Zeiler ,
A.M. Kaufmann ,
P.J. McDonald ,
D. Fewer ,
J. Butler ,
G. Schroeder  and
M. West
F.A. Zeiler*
Affiliation:
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
A.M. Kaufmann
Affiliation:
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
P.J. McDonald
Affiliation:
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
D. Fewer
Affiliation:
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
J. Butler
Affiliation:
Department of Radiation Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
G. Schroeder
Affiliation:
Department of Radiation Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
M. West
Affiliation:
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
*
Section of Neurosurgery, University of Manitoba, Health Sciences Center, GB-1 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada. Email: umzeiler@cc.umanitba.ca.
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Abstract

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Object:

To review our institutional experience with Gamma Knife (GK) stereotactic radiosurgery in treating focally recurrent high grade glial neoplasms of World Health Organization (WHO) grade III or IV.

Methods:

We conducted a retrospective cohort review of all patients treated with GK for focally recurrent high grade gliomas at our institution between November 2003 and April 2013. Data on age, sex, tumor volume, location and maximal diameter, presenting clinical status, complications and clinical outcome was recorded.

Results:

A total of 33 patients were identified. Four were lost to follow-up. Average post-GK and overall survival was 20.4 months (range: 3 – 72) and 63.3 months (range: 10 – 214) respectively. For WHO grade IV gliomas, the average post-GK and overall survival was 15.8 months (range: 3 – 77) and 40.1 months (range: 13 – 148) respectively. Similarily, for WHO grade III gliomas, the average post-GK and overall survival was 34.9 months (range: 6 – 72) and 136.4 months (range: 22 – 214) respectively. Twenty-two patients (75.9%) had post-GK edema, with 14 requiring dexamethasone and eight being asymptomatic. Four patients (13.8%) had imaging defined radiation necrosis.

Conclusions:

Gamma Knife SRS affords an extension of local tumor control, acceptable morbidity, and potentially prolonged survival, for highly selected patients with focally recurrent high grade glial neoplasms.

Résumé

RÉSUMÉObjectif:

Le but de l'étude était de revoir notre expérience institutionnelle de la radiochirurgie stétéotaxique par scalpel gamma (SG) pour traiter les récidives de néoplasies gliales de haut grade de malignité, soit de grade III ou IV de l'OMS.

Méthode:

Nous avons effectué une revue rétrospective de cohorte de tous les patients traités par SG pour une récidive focale d'un gliome de haut grade dans notre institution entre novembre 2003 et avril 2013. Nous avons recueilli les informations sur l'âge, le sexe, le volume de la tumeur, sa localisation et son diamètre maximal, l'état clinique du patient au moment de la consultation initiale, les complications et l'issue clinique.

Résultats:

Nous avons identifié 33 patients. Quatre ont été perdus au suivi. La survie moyenne post SG et la survie globale étaient de 20,4 mois (écart : 3 à 72 mois) et 63,3 mois (écart : 10 à 214) respectivement. La survie moyenne post SG et la survie globale étaient de 15,8 mois (écart : 3 à 77 mois) et 40,1 mois (écart : 13 à 148 mois) respectivement. Pour les gliomes de grade III de l'OMS, la survie moyenne post-SG et la survie globale étaient de 34,9 mois (écart : 6 à 72 mois) et 136,4 mois (écart : 22 à 214 mois) respectivement. Vingt-deux patients (75,9%) ont présenté un œdème post SG : 14 d'entre eux ont dû recevoir de la dexaméthasone et 8 étaient asymptomatiques. Quatre patients (13,8%) présentaient une radionécrose à l'imagerie.

Conclusions:

La radiochirurgie stétéotaxique par SG permet de prolonger le contrôle local de la tumeur avec une morbidité acceptable et une prolongation éventuelle de la survie chez des patients choisis avec soin qui présentent une récidive bien localisée d'une néoplasie gliale

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 6 , November 2013 , pp. 783 - 789
Copyright
Copyright © The Canadian Journal of Neurological 2013

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