Stereotactic Radiosurgery Versus Reoperation in Small Surgically Accessible Recurrent Glioblastoma

Area of Science:

• Neuro-oncology
• Neurosurgery
• Radiation Oncology

Background:

• Glioblastoma (GBM) frequently recurs despite multimodal therapy.
• Salvage options for recurrent GBM (rGBM) include reirradiation with stereotactic radiosurgery (SRS) and reoperation.
• A direct comparison of GK-SRS and reoperation in a homogeneous rGBM population is lacking.

Purpose of the Study:

• To compare the safety and efficacy of Gamma Knife (GK)-SRS versus reoperation for recurrent glioblastoma (rGBM).
• To evaluate post-recurrence survival (PRS) and complication rates between GK-SRS and reoperation in rGBM patients.

Main Methods:

• Retrospective study of surgically accessible rGBM between 2005-2022.
• Patients received adjuvant radiotherapy and were treated with either GK-SRS or reoperation upon recurrence.
• Propensity-score matching was used to control for baseline differences, including tumor volume and Karnofsky performance status.

Main Results:

• 119 patients were identified; 38 underwent GK-SRS and 81 underwent reoperation.
• After propensity-score matching (23 patients per group), PRS and overall survival were similar between GK-SRS and reoperation.
• The reoperation group experienced significantly higher complication rates (26.1% vs 4.3%, P = .040).

Conclusions:

• GK-SRS provides comparable survival outcomes to reoperation in patients with small, surgically accessible first recurrent glioblastoma.
• GK-SRS demonstrated a lower complication rate compared to reoperation.
• GK-SRS is a viable local salvage treatment for carefully selected, low-volume rGBM recurrences.