Hypofractionated stereotactic radiotherapy for unifocal and multifocal recurrence of malignant gliomas

To evaluate the efficacy and safety of stereotactic radiotherapy (SRT) for unifocal and multifocal recurrence of malignant gliomas. Between June 2007 and October 2010, 35 consecutive patients with 47 recurrent lesions were treated with salvage SRT at the University of Cincinnati. Thirty-three patients treated had a diagnosis of high grade glioma, four Grade III and twenty-nine Grade IV, while two patients initially were diagnosed with grade II tumors but recurred as high grade lesions. All patients had previously received a median dose of 59.4 Gy. Twenty-six patients were treated for a single lesion, and nine patients were treated for multiple lesions. Using SRT, patients were re-treated with a median total dose of 30 Gy in a median of five fractions. Median survival from diagnosis was 22 months and median survival following SRT was 8.6 months. The median survival following SRT for those patients treated for multifocal recurrence was 7.9 versus 10 months for those treated for unifocal recurrence (p = 0.7). Multivariate analysis showed local control of the SRT treated lesion(s) 6 months after SRT was associated with a significant improvement in survival (p ≤ 0.01). All patients tolerated their treatment well and completed their prescribed SRT as planned. Three patients (9 %) were felt to possibly have developed radiation necrosis following therapy. SRT was both well tolerated and efficacious with the local control provided by SRT resulting in improved overall survival. This benefit also seems to be apparent for patients with multi-focal recurrence.