Kite Trent, Bossinger Bryce, Yadlapalli Vineetha, Jaffee Stephen, Herbst John, Karlovits Stephen, Wegner Rodney E, Shepard Matthew J
Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, Pittsburgh, PA, USA.
Edward Via College of Osteopathic Medicine, Blacksburg, VA, USA.
J Neurooncol. 2025 Jul 21. doi: 10.1007/s11060-025-05156-0.
Management of recurrent high-grade glioma (rHGG) is challenging. Contemporary therapeutic approaches include systemic chemotherapy, resection, conventional radiation, and stereotactic radiosurgery (SRS). Stereotactic radiosurgery is increasingly utilized given its low toxicity rates and relative efficacy. As the pace of research on this topic is rapidly evolving, a comprehensive review of the existing literature is necessary.
A systematic review in accordance with the preferred reporting in systematic review and meta-analysis guidelines (PRISMA) was conducted. PubMed and Science Direct databases were queried for articles which reported a primary analysis on a cohort of patients with recurrent gliomas (WHO grade III and IV) treated with SRS. Articles meeting the inclusion criteria and satisfying the quality threshold were included in the final review.
In total 22 articles representing 1,191 patients satisfied the inclusion criteria and quality threshold. The articles spanned a time frame from 1999 to March 2025. Tumor subtypes were distributed as 245 (20.6%) grade III and 946 (79.4%) grade IV. Linear accelerator (LINAC) based SRS was the most frequently utilized SRS platform treating a median tumor volume of 9.9cm (range: 1.21-44.0) with a median prescription dose of 16.5 Gy. At one-year, the pooled actuarial survival was 53%. At the time of last radiographic follow up, the pooled local progression and distant progression were 58% and 35% respectively. Grade ≥ 3 toxicity ranged from 0 to 14%.
For patients undergoing SRS for rHGG, overall survival times are consistent with alternative salvage therapies (chemotherapy, resection, and conventional radiotherapy) with relatively low treatment-related toxicity. Certain factors such as age, Karnofsky performance status (KPS), WHO grade, and interval between primary tumor treatment and reccurence/salvage SRS may be important in predicting treatment response.
复发性高级别胶质瘤（rHGG）的管理具有挑战性。当代治疗方法包括全身化疗、手术切除、传统放疗和立体定向放射外科（SRS）。鉴于其低毒性率和相对疗效，立体定向放射外科的应用越来越广泛。由于关于该主题的研究进展迅速，有必要对现有文献进行全面综述。
按照系统评价和荟萃分析指南（PRISMA）中的首选报告方式进行系统评价。在PubMed和Science Direct数据库中查询报告了对接受SRS治疗的复发性胶质瘤（世界卫生组织III级和IV级）患者队列进行初步分析的文章。符合纳入标准并满足质量阈值的文章纳入最终综述。
共有22篇文章代表1191例患者符合纳入标准和质量阈值。这些文章涵盖了1999年至2025年3月的时间段。肿瘤亚型分布为245例（20.6%）III级和946例（79.4%）IV级。基于直线加速器（LINAC）的SRS是最常用的SRS平台，治疗的中位肿瘤体积为9.9cm（范围：1.21 - 44.0），中位处方剂量为16.5 Gy。一年时，汇总的精算生存率为53%。在最后一次影像学随访时，汇总的局部进展和远处进展分别为58%和35%。≥3级毒性范围为0%至14%。
对于接受SRS治疗rHGG的患者，总体生存时间与其他挽救性治疗（化疗、手术切除和传统放疗）一致，且治疗相关毒性相对较低。某些因素，如年龄、卡诺夫斯基功能状态（KPS）、世界卫生组织分级以及原发性肿瘤治疗与复发/挽救性SRS之间的间隔，可能对预测治疗反应很重要。
