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Mayur Sharma, Jason L. Schroeder, Paul Elson, Antonio Meola, Gene H. Barnett, Michael A. Vogelbaum, John H. Suh, Samuel T. Chao, Alireza M. Mohammadi, Glen H. J. Stevens, Erin S. Murphy and Lilyana Angelov

G lioblastoma (GBM) is the most malignant subtype constituting approximately 55% of all glial brain tumors. 10 , 31 Despite aggressive management, these tumors tend to recur within 6 months of treatment initiation, and the prognosis remains dismal. 52 , 54 Patients with recurrent GBM (rGBM) pose significant clinical management challenges, as no standard salvage treatment is currently available for these patients. 42 Options such as repeat resection, 57 , 58 laser interstitial thermal therapy (LITT), 46 , 47 , 60 repeat external-beam radiotherapy (EBRT) alone

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Jonathan G. Thomas, Ganesh Rao, Yvonne Kew and Sujit S. Prabhu

healing and the patient's functional status can hamper attempts of total resection. Moreover, recurrences often occur at sites close to functional or eloquent brain that were respected during the first surgery. Therefore, LITT may offer a cytoreductive option for focal GBM recurrences. We report our experience at MD Anderson Cancer Center using LITT for treatment of both newly diagnosed “unresectable” GBMs and recurrent GBMs. Methods We retrospectively reviewed patients with a diagnosis of GBM, either newly diagnosed or recurrent, who underwent LITT at MD

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Pantaleo Romanelli, Alfredo Conti, Antonio Pontoriero, Giuseppe Kenneth Ricciardi, Francesco Tomasello, Costantino De Renzis, Gualtiero Innocenzi, Vincenzo Esposito and Giampaolo Cantore

median survival ranging from 4 to 7 months in patients with recurrent disease. 7 , 8 , 10 , 16 , 57 Stereotactic radiosurgery, fSRT, and brachytherapy are logical adjuncts to current state-of-the-art treatments for recurrent GBM because of their ability to deliver high doses of radiation to a focal target. In comparing these options, radiosurgery appears to be the most convenient, offering a fast, noninvasive treatment that can be completed in one day, is usually well tolerated, and can be repeated. The main limitation of focal treatments is their inability to

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Sandeep Mittal, Neil V. Klinger, Sharon K. Michelhaugh, Geoffrey R. Barger, Susan C. Pannullo and Csaba Juhász

adults with newly diagnosed supratentorial GBM following maximal surgical debulking and completion of radiation therapy with concomitant standard-of-care chemotherapy. 27 TABLE 1. Current FDA-approved indications and contraindications of Optune Recurrent GBM (FDA approval on April 8, 2011) Indications Age 22 yrs or older Confirmed recurrent GBM after chemotherapy GBM in supratentorial location To be used as monotherapy As alternative to standard medical therapy after surgical & radiation options exhausted Contraindications Active implanted medical device present

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G. Evren Keles, Kathleen R. Lamborn, Susan M. Chang, Michael D. Prados and Mitchel S. Berger

recurrent GBMs at first relapse, PFS was better in the temozolomide-treated group, both in the proportion of patients whose disease was progression free at 6 months (13% higher: 21% compared with 8%) and in the median duration of PFS (4 weeks longer: 12.4 weeks compared with 8.3 weeks). 26 Although the median ST was 1.5 months longer in the temozolomide-treated group, this difference was not statistically significant. In another multicenter Phase II trial of temozolomide, which included 128 patients with histologically confirmed GBMs at first relapse, the PFS rate at 6

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Borimir J. Darakchiev, Robert E. Albright, John C. Breneman and Ronald E. Warnick

delay disease progression, including repeated operation, conformal radiation, brachytherapy, and local chemotherapy. 2 , 3 , 11 , 14 , 19 Local therapies deliver treatment to the tumor site, which limits exposure in other areas of the body and makes the local therapies ideal agents in multimodal treatment strategies. Permanent, low-activity 125 I seeds and BCNU wafers are 2 adjunct therapies that have been shown to be effective in recurrent GBM as part of multimodal regimens. Studies have demonstrated prolonged survival with permanent, low-activity 125 I seed

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Tomokazu Aoki, Tomohiko Mizutani, Kuniharu Nojima, Takehisa Takagi, Ryosuke Okumura, Yoshiaki Yuba, Tetsuya Ueba, Jun A. Takahashi, Shin-Ichi Miyatake, Kazuhiko Nozaki, Waro Taki and Masao Matsutani

established second-line treatments once the tumor progresses. 9 As shown in a published database of Phase II trials that included 225 patients with recurrent GBM, the benefit from chemotherapy in such patients is very limited. 31 The median duration of PFS is 9 weeks, and PFS at 6 months (PFS-6) is 15%, meaning that 15% of patients survive without tumor progression by 6 months after treatment. Several chemotherapeutic or biological agents may palliate patients but produce only a minimal increase in survival, although dose-intensified temozolomide or bevacizumab has shown

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Shuichi Izumoto, Akihiro Tsuboi, Yoshihiro Oka, Tsuyoshi Suzuki, Tetsuo Hashiba, Naoki Kagawa, Naoya Hashimoto, Motohiko Maruno, Olga A. Elisseeva, Toshiaki Shirakata, Manabu Kawakami, Yusuke Oji, Sumiyuki Nishida, Satoshi Ohno, Ichiro Kawase, Jun Hatazawa, Shin-ichi Nakatsuka, Katsuyuki Aozasa, Satoshi Morita, Junichi Sakamoto, Haruo Sugiyama and Toshiki Yoshimine

investigated the clinical responses to peptide-based immunotherapy targeting the WT1 gene product in patients with recurrent GBMs. We also evaluated the correlation between the clinical response and the WT1 expression level in tumor tissues using immunohistochemical staining, as well as WT1-specific CTL frequencies (tetramer assay) in patients' PBMCs. Clinical Materials and Methods The WT1 Peptide The immunization consisted of an HLA-A*2402–restricted, modified 9-mer WT1 peptide (amino acids 235–243 CYTWNQMNL), in which Y was substituted for M at amino acid

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Tene A. Cage, Melike Pekmezci, Michael Prados and Mitchel S. Berger

possible to decrease tumor burden, thereby improving overall patient survival time as well as quality of life. 1 , 6 Although MRI is the standard method of preoperative tumor detection, MRI alone may not be able to completely visualize the full extent of diffuse infiltrative glial tumors. In cases where there is a concern for diffuse tumor spread, supplemental techniques for tumor detection such as intraoperative 5-aminolevulinic acid (5-ALA) may be helpful in linking the recurrence to the primary site. 14 Here we describe a case of recurrent GBM, in which the lesion

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Anita Mahajan, Ian E. McCutcheon, Dima Suki, Eric L. Chang, Samuel J. Hassenbusch, Jeffrey S. Weinberg, Almon Shiu, Moshe H. Maor and Shiao Y. Woo

duration ranging from 4 to 8 months after recurrence. 1, 3 Hau and associates 6 have suggested that aggressive multimodal salvage treatment for recurrent GBMs results in a median overall survival duration of 16.3 months compared with 7 months in a control group in whom no salvage treatment was used. The use of radiotherapy in recurrent disease has been evaluated with promising results. Voynov, et al., 30 reported a median survival duration of 10.1 months with the use of hypofractionated intensity-modulated radiotherapy in patients who had undergone previous