Biologically Guided Gamma Knife Dose Painting for Recurrent High-Grade Gliomas: A Retrospective Study Using...

Area of Science:

• Neurosurgery
• Radiation Oncology
• Medical Imaging

Background:

• Recurrent high-grade gliomas present a significant treatment challenge.
• Salvage therapies are crucial for improving patient outcomes.
• Optimizing radiation delivery is key to enhancing treatment efficacy.

Purpose of the Study:

• To evaluate the efficacy of biologically guided dose painting in Gamma Knife stereotactic radiosurgery (GKSRS) for recurrent high-grade gliomas.
• To improve radiographic response by targeting radiation to aggressive tumor subregions.
• To assess the safety and effectiveness of this novel approach.

Main Methods:

• A single-arm cohort of 23 patients with recurrent high-grade glioma underwent GKSRS.
• Functional imaging, including magnetic resonance spectroscopy (MRS) and T1-weighted perfusion MRI (T1-PMRI), identified aggressive and passive tumor zones.
• A modified radiosurgery plan delivered 18 Gy to aggressive zones and 15 Gy to passive zones.

Main Results:

• Biologically guided dose painting showed no significant increase in whole-brain mean dose, integral dose, or V12 compared to a uniform-dose plan.
• Among 11 patients with follow-up, K-trans significantly decreased (median, -18%; P=0.028).
• Higher baseline K-trans correlated with greater K-trans reduction (r=-0.84, P=0.0012).

Conclusions:

• Advanced MRI techniques can effectively identify aggressive tumor subregions in recurrent high-grade gliomas.
• Biologically guided dose painting in GKSRS enhances treatment efficiency by focusing radiation on these zones.
• This approach improves radiographic response without increasing morbidity rates.