Case—control study of stereotactic radiosurgery for recurrent glioblastoma multiforme

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Object. The role of stereotactic radiosurgery (SRS) for recurrent glioblastoma multiforme (GBM) was evaluated in a case—control study.

Methods. All patients who underwent SRS for recurrent GBM before March 2003 formed the case group. A control group of patients who did not undergo SRS was created from an institutional database, and each case was matched for known prognostic factors in GBM. The medical and neuroimaging records of all the patients were reviewed, and survival and treatment outcomes were recorded.

The case and control groups were well matched with regard to demographics and pre-SRS interventions. In the control group, the date on which magnetic resonance imaging identified a recurrent lesion that would have been eligible for SRS was deemed the “SRS” date. The number of surgeries performed in the control group was statistically higher than that in the case group. The median duration of overall survival from diagnosis was 26 months in the case group and 23 months in the control group. From the date of SRS or “SRS”, the median duration of survival was 11 months in the case group and 10 months in the control group, a difference that was not statistically significant.

Conclusions. It appears that a subgroup of patients with GBMs has a higher than expected median survival duration despite the initial prognostic factors. In patients with localized recurrences, survival may be prolonged by applying aggressive local disease management by using either SRS or resection to equal advantage.

Article Information

Address reprint requests to: Anita Mahajan, M.D., Division of Radiation Oncology, University of Texas, M. D. Anderson Cancer Center, Unit 097, 1515 Holcombe Boulevard, Houston, Texas 77030. email: amahajan@mdanderson.org.

© AANS, except where prohibited by US copyright law.

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Figures

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    Bar graph demonstrating the number of surgeries in the case (SRS) and non-SRS (control) groups after SRS or “SRS.”

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    Bar graph showing the total number of chemotherapeutic regimens in patients who underwent SRS and those who did not from the time of diagnosis to the end of the study period.

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    Chart demonstrating the most commonly used chemotherapy agents and regimens and their periods of use. A-ifn = interferon-α; BCNU = carmustine; Carboplat. = carboplatinum; CCI-779 = Temsirolimus; CPT11 = irinotecan; CRA = cisretinoic acid; PCV = procarbazine, lomustine, and vincristine; STI-571 = Gleevec; Temozol = temozolomide; TPCH = thiotepa, procarbazine, carboplatin, and hydroxyurea; VP-16 = etoposide; 6-TG = 6-thioguanine.

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    Graphs depicting the actuarial survival curves of patients in the case and control groups from the time of diagnosis and from the time of SRS or “SRS.”

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