Radiosurgery for recurrent glioblastoma: a review article

Glioblastoma (GB) is the most common primary brain tumor in adults, accounting for more than half of all diffuse gliomas with an agressive disease course despite multimodality management.Too few patients with GB live more than 5 years, and there are several prognostic factors including age, performance status, and MGMT promoter methylation which is associated with response to Temozolomide treatment.Standard of care in newly diagnosed GB has been established in 2005 as concurrent chemoradiotherapy, based on the landmark European Organisation for Research and Treatment of Cancer (EORTC)/National Cancer Institute of Canada Clinical Trials Group (NCIC-CTG) study demonstrating a clinically meaningful and significant median overall survival benefit with the addition of Temozolomide to conventionally fractionated partial brain radiotherapy.However, recurrence is very common in an overwhelming majority of the patients with a grim prognosis.Several therapeutic strategies are employed in the recurrent setting with no established standard of care.Reoperation, repeat radiotherapy, chemotherapy, tumor treating fields, antiangiogenic and other targeted agents, experimental treatments and combinations of modalities have been used for management of patients with recurrent GB depending on tumor and patient characteristics.Herein, we review the use of radiosurgery for management of recurrent GB in light of the literature.