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Randomized
study of brachytherapy in the initial management of patients with malignant
astrocytoma
Laperriere
NJ, Leung PM, McKenzie S, Milosevic M, Wong S, Glen J, Pintilie M, Bernstein M
Department
of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
Purpose.
A randomized study was undertaken to assess the role of brachytherapy as a boost
to external beam radiation therapy in the initial management of patients with
malignant astrocytomas.
Methods
and Materials. Inclusion criteria included the following: biopsy-proven
supratentorial malignant astrocytoma of brain < or =6 cm in size, not
crossing midline or involving corpus callosum, age 18-70, Karnofsky Performance
Status (KPS) > or =70. Patients were randomized to external radiation therapy
only delivering 50 Gray (Gy) in 25 fractions over 5 weeks or external radiation
therapy plus a temporary stereotactic iodine-125 implants delivering a minimum
peripheral tumor dose of 60 Gy. Patients were stratified to age < or =50 or
>50, and KPS > or =90 or < or =80.
Results.
There were 140 patients randomized between 1986 and 1996, 71 to the implant arm
and 69 to external irradiation only. Pathologically 125 patients had necrosis
noted in their tumor specimen. Factors associated with improved survival in
univariate analysis were age < or =50, KPS > or =90, chemotherapy at
recurrence, and reoperation at the original tumor site. The Cox proportional
hazards model revealed the following significant factors: treatment at
recurrence (chemotherapy or reoperation) with a relative risk (RR) of 0.6 (p =
0.004) and KPS > or =90 with a RR 0.6 (p = 0.007). Randomization to the
implant arm was associated with a RR of 0.7 (p = 0.07). Median survival for
patients randomized to brachytherapy or not were 13.8 vs. 13.2 months,
respectively, p = 0.49.
Conclusions.
We conclude that stereotactic radiation implants have not demonstrated a
statistically significant improvement in survival in the initial management of
patients with malignant astrocytoma.
PMID:
9719109 [PubMed - indexed for MEDLINE]
Source:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9719109&dopt=Abstract |
