Article
Brachytherapy for the treatment of cerebral glioma WHO grade II – tumor recurrence or tumor rest after neurosurgical resection
Brachytherapie zur Behandlung zerebraler Gliome WHO Grad II - Tumorrezidiv oder Tumorrest nach neurochirurgischer Resektion
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Authors
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B. Suchorska
- Klinik für Neurologie II und Stereotaktische Neurochirurgie, Universitätsklinikum Magdeburg
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A. Ntouvali
- Klinik für Stereotaxie und funktionelle Neurochirurgie, Klinikum der Universität zu Köln
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D. Lenartz
- Klinik für Stereotaxie und funktionelle Neurochirurgie, Klinikum der Universität zu Köln
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V. Sturm
- Klinik für Stereotaxie und funktionelle Neurochirurgie, Klinikum der Universität zu Köln
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H.-J. Heinze
- Klinik für Neurologie II und Stereotaktische Neurochirurgie, Universitätsklinikum Magdeburg
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J. Voges
- Klinik für Neurologie II und Stereotaktische Neurochirurgie, Universitätsklinikum Magdeburg
| Published: | May 30, 2008 |
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Outline
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Objective: To analyze the value of brachytherapy (BT) as a key step in a multistage concept for the treatment of tumor recurrence or tumor rest of a glioma WHO grade II after neurosurgical resection.
Methods: From 01/1990 through 12/2006 we treated 1024 consecutive pts. with a neuroepithelial brain tumor using stereotactic implantation of Iodine-125 seeds and consecutive BT (cumulative radiation dose: 50-65 Gy). Computer-assisted 3D-treatment planning was performed using high resolution imaging and specialized software (STP, Stryker-Howmedica). In 91 patients with a glioma WHO grade II (median age: 36.2±12 years) considered for analysis, we treated a tumor rest (37 pts.) or recurrence (44 pts.) after previous tumor resection. Tumors were located in eloquent cerebral areas (92.3%), inside the diencephalon-brain stem (6.6%), or in the posterior fossa (1.1%). For the analysis of survival data we utilized Kaplan-Meier curves and Cox-regression.
Results: The median FU was 134.1±56.6 months (range: 23.8–247.2 mths.), the median cumulative progression free survival (PFS) time after first BT was 46.0±7.5 months. The 5-year and 10-year PFS probabilities were 50.3% and 5.3%, respectively. Multivariate analysis (histology: astrocytoma, oligodendroglioma, oligoastrocyoma, tumor rest vs. recurrence, malignisation: yes vs. no) showed that tumor malignisation (27 pts.) was the only unfavorable factor for PFS (p<0.05). Median PFS time within subgroup was 30.6 months vs. 81.6 months. Tumors recurring after the first BT (58.2%) were treated with second or third resection (38.5%), second brachytherapy (21%), chemotherapy (14.3%) and/or radiotherapy (18.5%). The median survival time from the initial diagnosis of a cerebral glioma until the patient’s last contact (overall survival) was 107.6±12.6 months. The only peri-/postoperative complication was a CSF-fistula (1 pt.).
Conclusions: Brachytherapy of a tumor rest or tumor recurrfenced following neurosurgical resection of a cerebral glioma WHO grade II is well tolerated by the patients. Referred to a multistep treatment concept it provides a reasonably long progression free interval postponing the need for chemotherapy and/or radiotherapy.
