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Clinical Therapy Trials-Radiation |
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
1 Address correspondence to David A. Larson, Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143 (larson{at}radonc17.ucsf.edu).
Abstract
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. Thirtyeight 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. Multivariate 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.
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