Stereotactic Irradiation of Low-grade Glioma Using a Leksell Gamma Knife

Česká verzia

Authors: G. Šimonová ¹; J. Šemnická ²; R. Liščák ¹
Authors place of work: Nemocnice Na Homolce, Praha Odd. stereotaktické a radiační neurochirurgie ¹; Nemocnice Na Homolce, Praha Odd. lékařské fyziky ²
Published in the journal: Cesk Slov Neurol N 2011; 74/107(3): 312-319
Category: Original Paper

Summary

Objective:
To evaluate treatment results, radiation-related toxicity and prognostic factors for progression free survival (PFS) in patients with low-grade glioma irradiated by Leksell Gamma Knife.

Materials and methods:
A total of 88 patients underwent hypofractionated stereotactic irradiation to treat low-grade glioma. The median minimum applied dose to the planning target volume (PTV) was 25 Gy (12–35). The dosage was prescribed with respect to the several conditions: number of fractions, previous irradiation, planning target volume and age. The radiation toxicity and severity of symptoms (neurological functional class [NFC]) were evaluated according to the RTOG/EORTC system. We analyzed variables affecting progression-free survival (PFS) after treatment and radiation-induced late toxicity (grade, age, volume, biologically effective dose, previous radiotherapy, NFC score before treatment). We used univariate analysis (Kaplan-Meier with log-rank test) and multivariate analysis (Cox regression) to detect differences in survival curves, as well as correlation analysis to detect variables associated with toxicity.

Results:
10-year PFS was 78%. As expected, we found a greater surviving proportion among grade I patients, (91% surviving at 5 years, 88% at 10 years) than grade II patients (79% surviving at 5 years, 67% at 10 years), p = 0.010 log-rank, p = 0.025 Cox. Among the other variables we detected as significant positive prognostic factors: age < 30 years (p = 0.044 log-rank), BED 85–110 Gy, which is an intermediate category, (p = 0.019 log-rank), and not previously irradiated (p = 0.032 log-rank, p = 0.075 Cox). In our group of patients we observed grade 3 late toxicity in 10% of cases. Among the variables analyzed we found none associated with incidence of toxicity.

Conclusion:
Radiosurgery is a treatment modality for small residual or reoccurrence volumes of low-grade glioma with relatively long-term local control.

Key words:
glioma – Leksell gamma knife – prognosis

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