Feasibility of fractionated gamma knife radiosurgery in the management of newly diagnosed Glioblastoma

• Published in: BMC cancer Vol. 22; no. 1; pp. 1 - 1095
• Main Authors: Gallitto, Matthew, Savacool, Michelle, Lee, Albert, Wang, Tony J. C, Sisti, Michael B
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 26-10-2022; BioMed Central; BMC
• Subjects: Biopsy; Brain cancer; Brain tumors; Care and treatment; Dosimetry; Frameless stereotactic radiosurgery; Gamma Knife; Gamma Knife ICON; Glioblastoma; Glioblastoma multiforme; Hypofractionation; Localization; Magnetic resonance imaging; Neuroimaging; Patients; Planning; Radiation therapy; Radiosurgery; Surgery; Survival; Temozolomide; Testing; United States
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-022-10162-w

Background Glioblastoma (GBM) is the most common primary malignant brain tumor in adults, with overall survival remaining poor despite ongoing efforts to explore new treatment paradigms. Given these outcomes, efforts have been made to shorten treatment time. Recent data report on the safety of CyberKnife (CK) fractionated stereotactic radiosurgery (SRS) in the management of GBM using a five-fraction regimen. The latest Gamma Knife (GK) model also supports frameless SRS, and outcomes using GK SRS in the management of primary GBM have not yet been reported. Objective To report on the feasibility of five-fraction SRS with the GammaKnife ICON in the management of newly diagnosed GBM. Methods In this single institutional study, we retrospectively reviewed all patients from our medical center from January 2017 through December 2021 who received fractionated SRS with Gamma Knife ICON for newly diagnosed GBM. Patient demographics, upfront surgical margins, molecular subtyping, radiation treatment volumes, systemic therapies, and follow-up imaging findings were extracted to report on oncologic outcomes. Results We identified six patients treated within the above time frame. Median age at diagnosis was 73.5 years, 66% were male, and had a median Karnofsky Performance Status (KPS) of 70. All tumors were IDH wild-type, and all but one were MGMT methylated and received concurrent temozolomide (TMZ). Within this group, progression free survival was comparable to that of historical data without significant radiation-induced toxicities. Conclusion Gamma Knife ICON may be discussed as a potential treatment option for select GBM patients and warrants further investigation in the prospective setting. Keywords: Frameless stereotactic radiosurgery, Gamma Knife, Gamma Knife ICON, Glioblastoma, Hypofractionation, Radiosurgery