Role Of Gamma Knife Radiosurgery In High Grade Gliomas

AZHAR RASHID1, Muhammad Abid Saleem2, Naveed Ahmad2, Muhammad Ali Memon2, A Sattar M2

1Pakistan Gamma KNife & Stereotactic Radiosurgery Center, Neurospinal & Medical Institute 2Pakistan Gamma Knife & Stereotactic Radiosurgery Center, Neurospinal & Medical Institute, Karachi, Pakistan

Keywords: gamma knife, anaplastic astrocytoma, glioblastoma multiforme, outcome, brain tumor

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     Studies have mentioned the role of gamma knife radiosurgery as a part of multimodality treatment to increase the local controls, time to progression of disease and overall survivals in selected patients.
     To describe the role of gamma knife radiosurgery in the management of patients with recurrent or unresectable high-grade gliomas. The worse prognosis of advanced high grade gliomas always promotes the clinicians to evolve the new approaches to deal with these types of aggressive tumors.
     During a 15-months interval, 54 patients underwent gamma knife stereotactic radiosurgery as part of multimodal treatment of their recurrent or unresectable high-grade gliomas. Forty one (75.9%) of these patients harbored anaplastic astrocytomas and 13 (24%) patients harbored World Health Organization Grade IV Glioblastoma multiforme (GBM). Median age was 35.5 years (range: 5-70 years). Tumors involved the parietal lobes in 19(35.2 %), frontal lobes in 12 (22.3%), brainstem in 9 (16.7%), temporoparietal regions in 5(9.3%), thalamus in five (9.3%), parasagittal region in 2(3.7%), parietooccipital and pineal region in 1(1.9%) patient each.
     In 39(72.2%) patients, diagnosis was confirmed with histopathology while 15 (27.8%) were diagnosed clinically, radiologically and with the help of spectroscopy. Multimodal treatment included surgery in 33(61.1%), fractionated radiotherapy in 15(27.8%) patients, chemotherapy in 6(11.1%). Ventriculoperitoneal shunt was placed in only 8 (14.8%). Tumor volumes ranged from 4.3 to 70 cm3. The median radiosurgical dose to the tumor margin was 11 Gy (range 7.5–16 Gy).Median maximum tumor dose was 23.80 Gy (range: 15-32.2 Gy).
     Only 10 patients had follow up images, four were of anaplastic astrocytoma and six were of GBM. Partial response was found in 3(30 %), stable disease in 3 (30%), progressive disease in 1 (10 %). No complete response achieved. No procedure-related death was encountered. Seven of 10 patients are alive at a median follow-up period of 8 months after radiosurgery .Three (30 %) patients died of local tumor progression after 8 months of radiosurgery. No significant radiation related side effects were noted.
     This is a retrospective study.
     Gamma Knife radiosurgery is a useful adjunctive intervention in the management of recurrent or unresectable high grade gliomas to have better local controls and increased time to progression of disease with lower complication rates.
     Further follow-ups will reveal the durability of response and survivals in our group of patients.


Project Roles:

A. RASHID (), M. Saleem (), N. Ahmad (), M. Memon (), A. M ()