Stereotactic radiosurgery for glioblastoma considering tumor genetic profiles: an international multicenter study.

Autor:	Bunevicius A; 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia., Pikis S; 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia., Kondziolka D; 2Department of Neurosurgery, NYU Langone Health, New York, New York., Patel DN; 2Department of Neurosurgery, NYU Langone Health, New York, New York., Bernstein K; 3Department of Radiation Oncology, NYU Langone Health, New York, New York., Sulman EP; 3Department of Radiation Oncology, NYU Langone Health, New York, New York., Lee CC; 4Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan.; 5School of Medicine, National Yang-Ming University, Taipei, Taiwan., Yang HC; 5School of Medicine, National Yang-Ming University, Taipei, Taiwan., Delabar V; 6Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada., Mathieu D; 6Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada., Cifarelli CP; 7Department of Neurosurgery, West Virginia University, Morgantown, West Virginia., Arsanious DE; 7Department of Neurosurgery, West Virginia University, Morgantown, West Virginia., Dahshan BA; 8Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia., Weir JS; 8Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia., Speckter H; 9Gamma Knife Radiology Department, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic., Mota A; 9Gamma Knife Radiology Department, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic., Tripathi M; 10Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India., Kumar N; 11Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India; and., Warnick RE; 12Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio., Sheehan JP; 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2021 Nov 05; Vol. 137 (1), pp. 42-50. Date of Electronic Publication: 2021 Nov 05 (Print Publication: 2022).
DOI:	10.3171/2021.7.JNS211277
Abstrakt:	Objective: Molecular profiles, such as isocitrate dehydrogenase (IDH) mutation and O6-methylguanine-DNA methyltransferase (MGMT) methylation status, have important prognostic roles for glioblastoma patients. The authors studied the efficacy and safety of stereotactic radiosurgery (SRS) for glioblastoma patients with consideration of molecular tumor profiles. Methods: For this retrospective observational multiinstitutional study, the authors pooled consecutive patients who were treated using SRS for glioblastoma at eight institutions participating in the International Radiosurgery Research Foundation. They evaluated predictors of overall and progression-free survival with consideration of IDH mutation and MGMT methylation status. Results: Ninety-six patients (median age 56 years) underwent SRS (median dose 15 Gy and median treatment volume 5.53 cm3) at 147 tumor sites (range 1 to 7). The majority of patients underwent prior fractionated radiation therapy (92%) and temozolomide chemotherapy (98%). Most patients were treated at recurrence (85%), and boost SRS was used for 12% of patients. The majority of patients harbored IDH wild-type (82%) and MGMT-methylated (62%) tumors. Molecular data were unavailable for 33 patients. Median survival durations after SRS were similar between patients harboring IDH wild-type tumors and those with IDH mutant tumors (9.0 months vs 11 months, respectively), as well as between those with MGMT-methylated tumors and those with MGMT-unmethylated tumors (9.8 vs. 9.0 months, respectively). Prescription dose > 15 Gy (OR 0.367, 95% CI 0.190-0.709, p = 0.003) and treatment volume > 5 cm3 (OR 1.036, 95% CI 1.007-1.065, p = 0.014) predicted overall survival after controlling for age and IDH status. Treatment volume > 5 cm3 (OR 2.215, 95% CI 1.159-4.234, p = 0.02) and absence of gross-total resection (OR 0.403, 95% CI 0.208-0.781, p = 0.007) were associated with inferior local control of SRS-treated lesions in multivariate models. Nine patients experienced adverse radiation events after SRS, and 7 patients developed radiation necrosis at 59 to 395 days after SRS. Conclusions: Post-SRS survival was similar as a function of IDH mutation and MGMT promoter methylation status, suggesting that molecular profiles of glioblastoma should be considered when selecting candidates for SRS. SRS prescription dose > 15 Gy and treatment volume ≤ 5 cm3 were associated with longer survival, independent of age and IDH status. Prior gross-total resection and smaller treatment volume were associated with superior local control.
Databáze:	MEDLINE
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