Stereotactic radiosurgery for recurrent high-grade gliomas: a systematic review.

IF 3.1 2区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuro-Oncology Pub Date : 2025-11-01 Epub Date: 2025-07-21 DOI:10.1007/s11060-025-05156-0

Trent Kite, Bryce Bossinger, Vineetha Yadlapalli, Stephen Jaffee, John Herbst, Stephen Karlovits, Rodney E Wegner, Matthew J Shepard

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引用次数: 0

Abstract

Purpose: 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.

Methods: 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.

Results: 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 9.9cm³ (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%.

Conclusions: 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.

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立体定向放射外科治疗复发性高级别胶质瘤：系统回顾。

目的：复发性高级别胶质瘤（rHGG）的治疗具有挑战性。目前的治疗方法包括全身化疗、切除、常规放疗和立体定向放射手术（SRS）。立体定向放射手术由于其低毒副作用和相对疗效而越来越多地被应用。随着这一主题的研究步伐的迅速发展，有必要对现有文献进行全面的回顾。方法：按照系统评价和荟萃分析指南（PRISMA）中的首选报告进行系统评价。我们查询了PubMed和Science Direct数据库中关于使用SRS治疗的复发性胶质瘤（WHO III级和IV级）患者队列初步分析的文章。符合纳入标准并满足质量阈值的文章被纳入最终评审。结果：共有22篇文章1191例患者满足纳入标准和质量阈值。这些文章的时间跨度从1999年到2025年3月。肿瘤亚型分布为245例（20.6%）III级和946例（79.4%）IV级。基于线性加速器（LINAC）的SRS是最常用的SRS平台，治疗中位肿瘤体积为9.9cm3（范围：1.21-44.0），中位处方剂量为16.5 Gy。一年的总精算生存率为53%。最后一次x线随访时，合并的局部进展和远处进展分别为58%和35%。≥3级毒性范围为0 ~ 14%。结论：对于接受SRS治疗的rHGG患者，总生存时间与替代挽救疗法（化疗、切除和常规放疗）一致，且治疗相关毒性相对较低。某些因素，如年龄，Karnofsky性能状态（KPS）， WHO分级，原发肿瘤治疗和复发/挽救性SRS之间的间隔可能是预测治疗反应的重要因素。

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来源期刊

Journal of Neuro-Oncology 医学-临床神经学

CiteScore

6.60

自引率

7.70%

发文量

277

审稿时长

3.3 months

期刊介绍： The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.