Sasame Jo, Shuto Takashi, Matsunaga Shigeo, Tomura Nagatsuki, Ohgaki Fukutaro, Iwamoto Kei, Fushimi Shuto, Aimi Hisao
Department of Neurosurgery, Yokohama Rosai Hospital, 3211 Kozukue-Cho, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan.
Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Neurosurg Rev. 2025 Jul 14;48(1):565. doi: 10.1007/s10143-025-03725-5.
No standard treatment for recurrent glioblastoma (rGBM) has been established. However, Gamma Knife radiosurgery (GKRS) is considered a viable option for local control. We aimed to examine the clinical characteristics of patients treated with GKRS for rGBM at our institution over 10 years. We retrospectively analyzed data of 38 patients who underwent GKRS for rGBM from April 2012 to March 2022, all of whom had received standard first-line treatment before recurrence. Forty-eight GKRS sessions were conducted on the 38 patients (stereotactic radiosurgery [SRS], 40; stereotactic radiotherapy, 8). The median marginal dose for SRS was 18 (range, 12-22) Gy. The median patient age was 62 (28-83) years. As part of postoperative chemoradiotherapy, radiation doses were 35 Gy for 1 patient, 40 Gy for 10 patients, and 60 Gy for 27 patients. The median time from surgery to GKRS was 11 (2-44) months. Adverse radiation effects included radiation necrosis in five patients (13%) and cerebral edema in two (5%). Progression at the GKRS site was observed in 24 patients (63%), with a median time to progression of 4.5 months. The median overall survival was 20 months, and that after GKRS was 12 months. A longer interval from surgery to GKRS (multivariable) and a total postoperative radiation dose of 60 Gy (univariate) were significant prognostic factors. GKRS shows promise as a treatment for rGBM, particularly for patients with a longer interval before recurrence and those receiving a 60-Gy postoperative radiation dose.
复发性胶质母细胞瘤（rGBM）尚无标准治疗方案。然而，伽玛刀放射外科手术（GKRS）被认为是实现局部控制的可行选择。我们旨在研究我院10年来接受GKRS治疗的rGBM患者的临床特征。我们回顾性分析了2012年4月至2022年3月期间38例接受GKRS治疗的rGBM患者的数据，所有患者在复发前均接受了标准一线治疗。对这38例患者进行了48次GKRS治疗（立体定向放射外科手术[SRS]40次，立体定向放射治疗8次）。SRS的中位边缘剂量为18（范围12 - 22）Gy。患者中位年龄为62（28 - 83）岁。作为术后放化疗的一部分，1例患者的放射剂量为35 Gy，10例患者为40 Gy，27例患者为60 Gy。从手术到GKRS的中位时间为11（2 - 44）个月。放疗不良反应包括5例（13%）放射性坏死和2例（5%）脑水肿。24例（63%）患者在GKRS部位出现进展，进展的中位时间为4.5个月。中位总生存期为20个月，GKRS后的中位生存期为12个月。从手术到GKRS的间隔时间更长（多变量）和术后总放射剂量60 Gy（单变量）是显著的预后因素。GKRS显示出作为rGBM治疗方法的前景，特别是对于复发前间隔时间较长以及接受60 Gy术后放射剂量的患者。
