Artikel
Experiences of treatment of recurrent glioblastoma multiforme with GliaSite 125I brachytherapy
Analysen der GliaSite I125-Brachytherapie bei Patienten mit Glioblastomrezidivtumoren
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Autoren
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K. Zinner
- Städtisches Krankenhaus Schwabing, Klinik für Neurochirurgie, München
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R. Dietl
- Städtisches Krankenhaus Schwabing, Klinik für Neurochirurgie, München
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E. Regnier
- Städtisches Krankenhaus Schwabing, Klinik für Neurochirurgie, München
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D. Sackerer
- Städtisches Krankenhaus Schwabing, Klinik für Neurochirurgie, München
| Veröffentlicht: | 11. April 2007 |
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Gliederung
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Objective: In this study, we analyzed the efficacy of GliaSite brachytherapy in the treatment of patients with recurrent glioblastoma multiforme (GBM) after maximal therapy, including patient survival and quality of life.
Methods: We retrospectively reviewed the clinical outcome of 28 patients with recurrent GBM and 1 patient with an anaplastic oligodendroglioma. All patients already had undergone primary resection of tumor, 27 patients had a following combined postoperative radiotherapy and temozolomide chemotherapy. After gross total resection of the recurrent GBM, an appropriately sized GliaSite balloon katheter was selected and placed in the resection cavity. Complete tumor resection and optimal size and position of the balloon were verified via MRI imaging with contrast. The balloon was afterloaded with Iotrex (aqueous iodine-125 radiotherapy solution) for 5 days to deliver a total dose of 60 Gy at a 1cm depth to the margins of resection, the area with the typically highest risk of recurrence of tumor. The mean age of patients were 54,1 (19-71) years, and the median Karnowsky performance status score was 80 (40-90). KPS score or tumor shape were no selection criteria for operation with GliaSite. Median follow-up time was 21,7 months (range 9-59 months).
Results: At the time of analyses, 19 (66%) patients had died. The median survival time of all patients from initial tumor diagnosis to death was 21,1 months (9-59). Median time between primary operation and tumor recurrence was 13,3 months (4-72). The median survival after GliaSite brachytherapy was 8,1 months (2-15). Treatment with Gliasite was usually well tolerated. One patient developed an intracerebral abscess, one a subdural hematoma and two incidents of symptomatic radiation necrosis were observed. KPS score was not chanced after GliaSite brachytherapy. Patients with KPS ≥80% were predicted for improved survival.
Conclusions: The treatment of recurrent GBM revision surgery combined with GliaSite brachytherapy is promising results according to survival rate. Randomized studies are required to evaluate the therapeutic benefit of this treatment.
