Clinical Scorecard: Failure Patterns After Salvage Stereotactic Radiosurgery for Recurrent High-Grade Gliomas

At a Glance

Key Highlights

• High-grade gliomas have poor prognosis with frequent local progression despite standard treatment.
• Salvage stereotactic radiosurgery (SRS) is a potential treatment option for recurrent disease with acceptable toxicity.
• Patterns of failure post-SRS include local (in-field, marginal, regional) and distant recurrences, assessed by RANO criteria.

Guideline-Based Recommendations

Diagnosis

• Confirm recurrence using Response Assessment in Neuro-Oncology (RANO) criteria.
• Histological confirmation of high-grade glioma (WHO Grade III or IV) per 2016 WHO CNS classification.

Management

• Consider salvage single-fraction Gamma Knife SRS targeting enhancing recurrent lesions after multidisciplinary evaluation.
• Dose selection and target volume delineation should be decided collaboratively by radiation oncologist and neurosurgeon.
• SRS delivered as outpatient procedure with same-day discharge.

Monitoring & Follow-up

• Perform follow-up MRI every 2 months post-SRS to assess for tumor progression or recurrence.
• Evaluate treatment toxicity using Common Terminology Criteria for Adverse Events (CTCAE) version 5.

Risks

• Potential for local failure including in-field, marginal, regional, and distant recurrences.
• Cumulative brain radiation dose limits reirradiation options and risk to critical brain regions.

Patient & Prescribing Data

Adults with recurrent high-grade gliomas previously treated with surgery, chemotherapy, and radiation.

Salvage SRS may improve local control with acceptable toxicity; patient selection based on clinical and demographic factors is important.

Clinical Best Practices

• Use multidisciplinary team approach for treatment planning and patient selection for salvage SRS.
• Employ high-resolution contrast-enhanced MRI for precise target delineation post stereotactic frame placement.
• Incorporate intra-patient clustering in outcome analyses to account for multiple lesions per patient.
• Assess failure patterns relative to prescription isodose lines to guide future treatment planning.

References

• 2016 WHO Classification of Tumors of the CNS
• Response Assessment in Neuro-Oncology (RANO) criteria
• Common Terminology Criteria for Adverse Events (CTCAE) version 5