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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Survival analysis of HDR brachytherapy versus reoperation versus temozolomide alone: a cohort analysis for recurrent glioblastoma multiforme

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  • Eleftherios Archavlis - Klinik für Neurochirurgie, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland
  • Nikolaos Tselis - Department of Radiotherapy and Interdisciplinary Oncology, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland
  • Jasmin Kraft - Klinik für Neurochirurgie, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland
  • Gerhard Birn - Klinik für Neurochirurgie, Klinikum Darmstadt, Akademisches Lehrkrankenhaus der Universität Frankfurt, Darmstadt, Deutschland
  • Peter Ulrich - Klinik für Neurochirurgie, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland; Department of Radiotherapy and Interdisciplinary Oncology, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland
  • Dimos Baltas - Department of Medical Physics and Engineering, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland
  • Nikolaos Zamboglou - Department of Radiotherapy and Interdisciplinary Oncology, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocDI.06.09

doi: 10.3205/13dgnc214, urn:nbn:de:0183-13dgnc2142

Published: May 21, 2013

© 2013 Archavlis et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Tumor recurrence of glioblastoma multiforme (GBM) after initial treatment with surgical resection, radiotherapy, and chemotherapy is an inevitable phenomenon. This retrospective cohort study compared the efficacy of interstitial high dose rate brachytherapy (HDR-BRT), re-resection and dense dose temozolomide chemotherapy alone (ddTMZ) in the treatment of recurrent glioblastoma after initial surgery and radiochemotherapy

Method: From January 2005 to December 2010, a total of 111 patients developed recurrent GBM after initial surgery and radiotherapy with concomitant temozolomide. To treat the recurrence, 50 patients received a HDR-BRT, 36 patients underwent reoperation and, 25 patients had ddTMZ as the only salvage treatment.

Results: The median overall survival in the HDR-BRT, reoperation and ddTMZ groups was 82, 64 and 48 weeks respectively, whereas the median survival after salvage therapy of the recurrence was 37, 30 and 26 weeks respectively. The HDR-BRT group did significantly better than both the reoperation (p < 0.05) and the ddTMZ groups (p < 0.05). Moderate to severe complications in the HDR-BRT, reoperation and chemotherapy alone groups occurred in 5/50 (10%), 4/36 (11%) and 9/25 (36%) cases respectively.

Conclusions: CT-guided interstitial HDR brachytherapy attained higher survival benefits in the management of recurrent glioblastoma after initial surgery and radiotherapy with concurrent temozolomide in comparison with the other treatment modalities. The low risk of complications of the HDR-BRT and the fact that it can be delivered percutaneously under local anaesthesia render it a preferred treatment option for selected patients.