Gamma knife for glioma: Selection factors and survival

Larson, David A.; Gutin, Philip H.; McDermott, Michael; Lamborn, Kathleen; Sneed, Penny K.; Wara, William M.; Flickinger, John C.; Kondziolka, Douglas; Lunsford, L. Dade; Hudgins, W. Robert; Friehs, Gerhard M.; Haselsberger, Klaus; Leber, Klaus; Pendl, Gerhard; Chung, Sang Sup; Coffey, Robert J.; Dinapoli, Robert; Shaw, Edward G.; Vermeulen, Sandra; Young, Ronald F.; Hirato, Masafumi; Inoue, Hiroshi K.; Ohye, Chihiro; Shibazaki, Toru

doi:10.1016/S0360-3016(96)00427-0

« Previous Next »International Journal of Radiation Oncology * Biology * Physics
Volume 36, Issue 5 , Pages 1045-1053, 1 December 1996

Gamma knife for glioma: Selection factors and survival

David A. Larson, M.D., Ph.D.
- Reprint requests to: David A Larson, M.D., Ph.D., Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA 94143.
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
Philip H. Gutin, M.D.
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
Michael McDermott, M.D.
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
Kathleen Lamborn, Ph.D.
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
Penny K. Sneed, M.D.
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
William M. Wara, M.D.
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
John C. Flickinger, M.D.
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Douglas Kondziolka, M.D.
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
L. Dade Lunsford, M.D.
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
W. Robert Hudgins, M.D.
- Department of Neurological Surgery, Presbyterian Hospital, Dallas, TX, USA
Gerhard M. Friehs, M.D.
- Department of Neurological Surgery, Karl-Franzens-University, Graz, Austria
Klaus Haselsberger, M.D.
- Department of Neurological Surgery, Karl-Franzens-University, Graz, Austria
Klaus Leber, M.D.
- Department of Neurological Surgery, Karl-Franzens-University, Graz, Austria
Gerhard Pendl, M.D.
- Department of Neurological Surgery, Karl-Franzens-University, Graz, Austria
Sang Sup Chung, M.D.
- Department of Neurological Surgery, Yonsei University College of Medicine, Seoul, Korea
Robert J. Coffey, M.D.
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
Robert Dinapoli, M.D.
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
Edward G. Shaw, M.D.
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
Sandra Vermeulen, M.D.
- Department of Radiation Oncology, Northwest Hospital, Seattle, WA, USA
Ronald F. Young, M.D.
- Department of Neurological Surgery, Northwest Hospital, Seattle, WA, USA
Masafumi Hirato, M.D.
- Department of Neurological Surgery, Gunma University School of Medicine, Maebashi City, Japan
Hiroshi K. Inoue, M.D.
- Department of Neurological Surgery, Gunma University School of Medicine, Maebashi City, Japan
Chihiro Ohye, M.D.
- Department of Neurological Surgery, Gunma University School of Medicine, Maebashi City, Japan
Toru Shibazaki, M.D.
- Department of Neurological Surgery, Hidaka Hospital, Takasaki City, Japan

Accepted 26 August 1996.

Abstract

Purpose: To determine factors associated with survival differences in patients treated with radiosurgery for glioma.

Methods and Materials: We analyzed 189 patients treated with Gamma Knife radiosurgery for primary or recurrent glioma World Health Organization (WHO) Grades 1–4.

Results: The median minimum tumor dose was 16 Gy (8–30 Gy) and the median tumor volume was 5.9 cc (1.3–52 cc.) Brachytherapy selection criteria were satisfied in 65% of patients. Median follow-up of all surviving patients was 65 weeks after radiosurgery. For primary glioblastoma patients, median survival from the date of pathologic diagnosis was 86 weeks if brachytherapy criteria were satisfied and 40 weeks if they were not (p = 0.01), indicating that selection factors strongly influence survival. Multivariate analysis showed that increased survival was associated with five variables: lower pathologic grade, younger age, increased Karnofsky performance status (KPS), smaller tumor volume, and unifocal tumor. Survival was not found to be significantly related to radiosurgical technical parameters (dose, number of isocenters, prescription isodose percent, inhomogeneity) or extent of preradiosurgery surgery. We developed a hazard ratio model that is independent of the technical details of radiosurgery and applied it to reported radiosurgery and brachytherapy series, demonstrating a significant correlation between survival and hazard ratio.

Conclusions: Survival after radiosurgery for glioma is strongly related to five selection variables. Much of the variation in survival reported in previous series can be attributed to differences in distributions of these variables. These variables should be considered in selecting patients for radiosurgery and in the design of future studies.

Keywords: Brachytherapy, Brain neoplasm, Complications, Gamma knife, Malignant glioma, Radiosurgery, Survival

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