Purpose: To evaluate the role of stereotactic radiosurgery in the mana
gement of recurrent malignant gliomos. Patients and Methods: We treate
d 35 patients with large (median treatment volume, 28 cm(3)) recurrent
tumors that had failed to respond to conventional treatment. Twenty-s
ix patients (74%) had glioblastomas multiforme (GBM) and nine (26%) ha
d anaplastic astrocytomas (AA). Results: The mean time from diagnosis
to radiosurgery was 10 months (range, 1 to 36), from radiosurgery to d
eath, 8.0 months (range, 1 to 23). Twenty-one GBM (81%) and six AA (67
%) patients have died. The actuarial survival time for all patients wa
s 21 months from diagnosis and 8 months from radiosurgery. Twenty-two
of 26 patients (85%) died of local or marginal failure, three (12%) of
noncontiguous failure, and one (4%) of CSF dissemination. Age (P = .0
405) was associated with improved survival on multivariate analysis, a
nd age (P = .0110) and Karnofsky performance status (KPS) (P = .0285)
on univariate analysis. Histology, treatment volume, and treatment dos
e were not significant variables by univariate analysis. Seven patient
s required surgical resection for increasing mass effect a mean of 4.0
months after radiosurgery, for an actuarial reoperation rate of 31%.
Surgery did not significantly influence survival. At surgery, four pat
ients had recurrent tumor, two had radiation necrosis, and one had bot
h tumor and necrosis. The actuarial necrosis rate was 14% and the path
ologic findings could have been predicted by the integrated logistic f
ormula for developing symptomatic brain injury. Conclusion: Stereotact
ic radiosurgery appears to prolong survival for recurrent malignant gl
iomas and has a lower reoperative rate for symptomatic necrosis than d
oes brachytherapy. Patterns of failure ore similar for both of these t
echniques.