Sallabanda Morena, Arrojo Álvarez Elisabeth Estefanía, Aguilar Borja, Ruiz Echevarría Ana Lucrecia, Huertas Modéjar Helena, Sallabanda Kita
Radiation Oncology, Institute of Advanced Radiosurgery (IRCA), Madrid, ESP.
Oncology, Instituto Médico de Oncología Avanzada (INMOA), Madrid, ESP.
Cureus. 2025 May 5;17(5):e83511. doi: 10.7759/cureus.83511. eCollection 2025 May.
High-grade gliomas (HGGs) are the most common primary malignant brain neoplasms in adults, with a high rate of local relapse in the first two years after primary treatment, resulting in poor prognosis. The aim of this study is to describe the potential benefits of the implementation of gyroscopic radiosurgery (GRS) in combination with modulated electro-hyperthermia (mEHT) as a radiosensitizer for the reirradiation of large or multifocal recurrent HGGs.
A study was designed to evaluate the impact of survival and clinical tolerance. Clinical information of 15 patients treated between April 2023 and September 2024 was analyzed.
Fifteen patients with a median age of 50 years and grade 4 (n = 13) or grade 3 (n = 2) gliomas were included in the study. The median Karnofsky Performance Status (KPS) was 70. Multifocal disease was present in 10 patients. The median time from previous radiation was 16 months. Twelve patients were eligible for analysis. The median planning target volume (PTV) was 33.6 cc; 48% (10 lesions) received five fractions (20-30 Gy), 38% (eight lesions) received one fraction (15-18 Gy), and 14% (three lesions) received three fractions (24 Gy). mEHT was applied every 48 hours. The median follow-up was seven months with no in-field recurrences reported. Actuarial overall survival (OS) from GRS and mEHT was 58.3% at six months and 25% at 12 months. Acute tolerance was acceptable, with 33.3% of patients showing improvement, 33.3% remaining stable, and 33.3% presenting grade 2 radiation necrosis, managed with outpatient steroid adjustment.
High-risk, HGG reirradiation with GRS and mEHT showed a favorable impact on local control and OS with low toxicity. Longer follow-up and larger series are needed to validate these results.
高级别胶质瘤（HGGs）是成人中最常见的原发性恶性脑肿瘤，在初次治疗后的头两年内局部复发率很高，导致预后不良。本研究的目的是描述实施陀螺刀放射外科手术（GRS）联合调制式电超热疗法（mEHT）作为放射增敏剂对大型或多灶性复发性HGGs进行再照射的潜在益处。
设计一项研究以评估生存情况和临床耐受性的影响。分析了2023年4月至2024年9月期间接受治疗的15例患者的临床信息。
该研究纳入了15例患者，中位年龄为50岁，胶质瘤分级为4级（n = 13）或3级（n = 2）。中位卡氏功能状态评分（KPS）为70。10例患者存在多灶性病变。距上次放疗的中位时间为16个月。12例患者符合分析条件。中位计划靶体积（PTV）为33.6 cc；48%（10个病灶）接受5次分割（20 - 30 Gy），38%（8个病灶）接受1次分割（15 - 18 Gy），14%（3个病灶）接受3次分割（24 Gy）。每48小时进行一次mEHT。中位随访时间为7个月，未报告野内复发情况。GRS和mEHT治疗后的精算总生存率（OS）在6个月时为58.3%，12个月时为25%。急性耐受性可接受，33.3%的患者病情改善，33.3%保持稳定，33.3%出现2级放射性坏死，通过门诊调整类固醇药物进行处理。
GRS和mEHT对高危HGGs进行再照射对局部控制和总生存率显示出有利影响，且毒性较低。需要更长时间的随访和更大规模的系列研究来验证这些结果。
