International Stereotactic Radiosurgery Society (ISRS) practice guidelines for radiosurgery in recurrent high-grade glioma
Bibliographic record
Abstract
BACKGROUND: Recurrence invariably occurs in patients with high-grade glioma (HGG) despite maximal definitive therapy. Currently, there is no standard-of-care salvage treatment approach and re-irradiation is considered an option for select patients. Various radiotherapy fractionation schedules have been investigated, including the use of stereotactic radiosurgery (SRS). The aim of this study was to provide clinical practice recommendations on behalf of the International Stereotactic Radiosurgery Society (ISRS) specific to salvage SRS for recurrent-HGG. We define SRS as focal radiation in a single fraction and hypofractionated radiosurgery (HFSRS) as focal radiation delivered over 2-5 fractions. METHODS: A literature review and meta-analysis were performed according to PRISMA guidelines. Recommendations were formulated according to DELPHI methodology. RESULTS: Sixty-two studies met the eligibility criteria for analyses, resulting in 2640 recurrent HGG patients. Stereotactic radiosurgery to a median total dose of 16 Gy was performed in 75% of patients, and HFSRS to the remaining 25% with a median total dose and number of fractions of 25 Gy and 5 fractions, respectively. The median overall survival from re-irradiation was 10.2 months. The pooled neurological toxicity rates were lower with HFSRS compared to SRS (4% vs. 7%, P = 0.001). A cumulative EQD2 greater than 120-130 Gy was significantly associated with a greater risk of radiation necrosis (P = 0.003). CONCLUSIONS: Focal re-irradiation with 16 Gy in single fraction or 24-25 Gy in 3-5 fractions, is safe and appears to be effective for recurrent-HGG. We also present clinical practice recommendations on behalf of the ISRS. Given the limited prospective data, no definitive conclusions can be drawn.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.041 | 0.069 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.005 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.005 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".