Valerio José E, Wolf Aizik L, Mantilla-Farfan Penelope, Aguirre Vera Guillermo de Jesús, Fernández-Gómez María P, Alvarez-Pinzon Andrés M
Department of Neurosurgery, Neurosurgery Oncology Center of Excellence, Miami Neuroscience Center at Larkin, South Miami, FL 33143, USA.
GW School of Business, The George Washington University, Washington, DC 20052, USA.
J Pers Med. 2024 Oct 10;14(10):1049. doi: 10.3390/jpm14101049.
Gamma Knife Radiosurgery (GKRS), a specific type of Stereotactic Radiosurgery (SRS), has developed as a significant modality in the treatment of glioblastoma, particularly in conjunction with standard chemotherapy. The goal of this study is to evaluate the efficacy of combining GKRS with surgical resection and chemotherapy in enhancing therapeutic effects for glioblastoma patients aged 55 years and older.
This prospective clinical study, conducted in accordance with the STROBE guidelines, involved 49 glioblastoma patients aged 55 years and older, treated between January 2013 and January 2023. Data were collected prospectively, and strict adherence to the STUPP protocol was maintained. Only patients who conformed to the STUPP protocol were included in the analysis. Due to concerns regarding the cognitive impairment associated with conventional radiotherapy, and at the patients' request, a radiosurgery plan was offered. Radiosurgery was administered for 4-8 weeks following surgical resection. Any patients who had not received previous radiotherapy received open surgical tumor removal, followed by GKRS along with adjuvant chemotherapy.
In this prospective clinical study of 49 glioblastoma patients aged 55 years and older, the average lifespan post-histopathological diagnosis was established at 22.3 months (95% CI: 12.0-28.0 months). The median time before disease progression was 14.3 months (95% CI: 13.0-29.7 months). The median duration until the first recurrence after treatment was 15.2 months, with documented cases varying between 4 and 33 months. The Gamma Knife Radiosurgery (GKRS) treatment involved a median marginal recommended dose of 12.5 Gy, targeting an average volume of 5.7 cm (range: 1.6-39 cm). Local recurrence occurred in 21 patients, while distant recurrence was identified in 8 patients. Within the cohort, 34 patients were subjected to further therapeutic approaches, including reoperation, a second GKRS session, the administration of bevacizumab and irinotecan, and PCV chemotherapy. A cognitive function assessment revealed that the patients treated with GKRS experienced significantly less cognitive decline compared to the historical controls, who were treated with conventional radiotherapy. The median MMSE scores declined by 1.9 points over 12 months, and the median MoCA scores declined by 2.9 points.
This study demonstrates that Gamma Knife Radiosurgery (GKRS), when integrated with surgical resection and adjuvant chemotherapy, offers a substantial benefit for glioblastoma patients aged 55 years and older. The data reveal that GKRS not only prolongs overall survival and progression-free survival but also significantly reduces cognitive decline compared to conventional radiotherapy. These findings underscore the efficacy and safety of GKRS, advocating for its incorporation into standard treatment protocols for older glioblastoma patients. The potential of GKRS to improve patient outcomes while preserving cognitive function is compelling and warrants further research to optimize and confirm its role in glioblastoma management.
伽玛刀放射外科手术（GKRS）是立体定向放射外科手术（SRS）的一种特殊类型，已发展成为治疗胶质母细胞瘤的一种重要方式，尤其是与标准化疗联合使用时。本研究的目的是评估GKRS联合手术切除及化疗对55岁及以上胶质母细胞瘤患者增强治疗效果的疗效。
本前瞻性临床研究按照STROBE指南进行，纳入了2013年1月至2023年1月期间治疗的49例55岁及以上的胶质母细胞瘤患者。数据前瞻性收集，并严格遵循STUPP方案。仅符合STUPP方案的患者纳入分析。由于担心传统放疗相关的认知障碍，且应患者要求，提供了放射外科手术方案。放射外科手术在手术切除后4 - 8周进行。所有未接受过放疗的患者均接受开放性手术肿瘤切除，随后进行GKRS及辅助化疗。
在这项对49例55岁及以上胶质母细胞瘤患者的前瞻性临床研究中，组织病理学诊断后的平均生存期为22.3个月（95%置信区间：12.0 - 28.0个月）。疾病进展前的中位时间为14.3个月（95%置信区间：13.0 - 29.7个月）。治疗后首次复发的中位持续时间为15.2个月，有记录的病例在4至33个月之间。伽玛刀放射外科手术（GKRS）治疗的中位边缘推荐剂量为12.5 Gy，靶体积平均为5.7 cm（范围：1.6 - 39 cm）。21例患者发生局部复发，8例患者发生远处复发。在该队列中，34例患者接受了进一步的治疗方法，包括再次手术、第二次GKRS治疗、贝伐单抗和伊立替康治疗以及PCV化疗。认知功能评估显示，与接受传统放疗的历史对照患者相比，接受GKRS治疗的患者认知功能下降明显更少。MMSE评分在12个月内中位下降1.9分，MoCA评分中位下降2.9分。
本研究表明，伽玛刀放射外科手术（GKRS）与手术切除及辅助化疗相结合，对55岁及以上的胶质母细胞瘤患者有显著益处。数据显示，与传统放疗相比，GKRS不仅延长了总生存期和无进展生存期，还显著减少了认知功能下降。这些发现强调了GKRS的疗效和安全性，主张将其纳入老年胶质母细胞瘤患者的标准治疗方案。GKRS在改善患者预后的同时保留认知功能的潜力令人信服，值得进一步研究以优化并确认其在胶质母细胞瘤治疗中的作用。
