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Background and objectives <p>Re-irradiation with stereotactic radiosurgery (SRS) is an increasingly used treatment for recurrent high-grade glioma (HGG). We analyzed the patterns of failure after salvage SRS to better identify which patients would most benefit.</p> Methods <p>We reviewed all patients who received SRS for recurrent HGG over 12 years at our institution. Pattern of failure was defined by the distance of recurrence from the SRS isodose line. Overall-survival (OS), progression-free survival (PFS), and local-failure-free survival (LFS) were estimated using Kaplan-Meier methods, and regression model analysis was performed to analyze clinical predictors of failure.</p> Results <p>146 patients with HGG underwent SRS treatment to 410 target lesions. The median target volume was 3.3 cm3 and median total dose was 18 Gy. Sixty-one (41.8%) patients developed progression following SRS. PFS at 6 and 12 months were 65.8% and 37.3% respectively. Median OS was 12.4 months from salvage SRS. There were 113 (79.5%) local failures, 2 (1.4%) distant, and 27 (19%) concomitant local and distant failures. LFS at 1 and 2 years was 65.1% and 40.4%, respectively. Non-white race (HR = 0.60), SRS dose ≥ 20 Gy (HR = 0.34), and KPS ≥ 70 (HR = 0.44) were associated with longer time to local failure, and age ≥ 60 years (HR = 2.29) was associated with shorter time to local failure. Non-white race (HR = 5.55) and SRS dose ≥ 20 Gy (HR = 5.62) were associated with more distant failure.</p> Conclusion <p>The dominant pattern of failure remains local and in-field despite conformal dose distribution with SRS and infiltrative tumor histology. This supports the role of reirradiation with SRS in well-selected patients with recurrent HGG.</p>

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Patterns of failure following stereotactic radiosurgery salvage for recurrent high-grade glioma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月14日

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  • Shivani Bindal,
  • Brandon Gonzalez,
  • Antonio Dono,
  • Roy Riascos,
  • Jay-Jiguang Zhu,
  • Sigmund Hsu,
  • Nitin Tandon,
  • Angel Blanco,
  • Yoshua Esquenazi,
  • Mark Amsbaugh

摘要

Background and objectives

Re-irradiation with stereotactic radiosurgery (SRS) is an increasingly used treatment for recurrent high-grade glioma (HGG). We analyzed the patterns of failure after salvage SRS to better identify which patients would most benefit.

Methods

We reviewed all patients who received SRS for recurrent HGG over 12 years at our institution. Pattern of failure was defined by the distance of recurrence from the SRS isodose line. Overall-survival (OS), progression-free survival (PFS), and local-failure-free survival (LFS) were estimated using Kaplan-Meier methods, and regression model analysis was performed to analyze clinical predictors of failure.

Results

146 patients with HGG underwent SRS treatment to 410 target lesions. The median target volume was 3.3 cm3 and median total dose was 18 Gy. Sixty-one (41.8%) patients developed progression following SRS. PFS at 6 and 12 months were 65.8% and 37.3% respectively. Median OS was 12.4 months from salvage SRS. There were 113 (79.5%) local failures, 2 (1.4%) distant, and 27 (19%) concomitant local and distant failures. LFS at 1 and 2 years was 65.1% and 40.4%, respectively. Non-white race (HR = 0.60), SRS dose ≥ 20 Gy (HR = 0.34), and KPS ≥ 70 (HR = 0.44) were associated with longer time to local failure, and age ≥ 60 years (HR = 2.29) was associated with shorter time to local failure. Non-white race (HR = 5.55) and SRS dose ≥ 20 Gy (HR = 5.62) were associated with more distant failure.

Conclusion

The dominant pattern of failure remains local and in-field despite conformal dose distribution with SRS and infiltrative tumor histology. This supports the role of reirradiation with SRS in well-selected patients with recurrent HGG.