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Permanent
iodine 125 brachytherapy in patients with progressive or recurrent glioblastoma
multiforme
David
A. Larson, Jeffrey M. Suplica, Susan M. Chang, Kathleen R. Lamborn, Michael W.
McDermott, Penny K. Sneed, Michael D. Prados, William M. Wara, M. Kelly Nicholas,
Mitchel S. Berger
Departments of Radiation Oncology (D.A.L., J.M.S., M.W.M.,
P.K.S., W.M.W.) and Neurological Surgery (D.A.L., S.M.C., K.R.L., M.W.M.,
M.D.P., M.K.N., M.S.B.),University of California San Francisco, San Francisco,
CA 94143, USA
This
study reports the initial experience at the University of California San
Francisco (UCSF) with tumor resection and permanent, low-activity iodine 125 (125I)
brachytherapy in patients with progressive or recurrent glioblastoma multiforme
(GM) and compares these results to those of similar patients treated previously
at UCSF with temporary brachytherapy without tumor resection.
Thirty-eight patients with progressive or recurrent GM were treated at UCSF with
repeat craniotomy, tumor resection, and permanent, low-activity 125I
brachytherapy between June 1997 and May 1998.
Selection criteria were Karnofsky performance score ≥ 60, unifocal,
contrast-enhancing, well-circumscribed progressive or recurrent GM that was
judged to be completely resectable, and no evidence of leptomeningeal or
subependymal spread.
The median brachytherapy dose 5 mm exterior to the resection cavity was 300 Gy
(range, 150 -500 Gy).
One patient was excluded from analysis.
Median survival was 52 weeks from the date of brachytherapy.
Age, Karnofsky performance score, and preimplant tumor volume were all
statistically significant on univariate analyses.
Multi variate analysis for survival showed only age to be significant.
Median time to progression was 16 weeks.
Both univariate and multivariate analysis of freedom from progression showed
only preoperative tumor volume to be significant.
Comparison to temporary brachytherapy patients showed no apparent difference in
survival time.
Chronic steroid requirements were low in patients with minimal postoperative
residual tumor.
We conclude that permanent 125I brachytherapy for recurrent or
progressive GM is well tolerated.
Survival time was comparable to that of a similar group of patients treated with
temporary brachytherapy.
© 2004 Duke
University Press
Source: http://konstanza.ingentaselect.com/vl=2506173/cl=81/nw=1/rpsv/cgi-bin/linker?ini=dup_no&reqidx=/cw/dup/15228517/v6n2/s5/p119
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