Interstitial Brachytherapy versus Cytoreductive Surgery in Recurrent Malignant Glioma

T.C Ryken; P.W Hitchon; J.C VanGilder; B.C Wen; S Jani

doi:10.1159/000100320

In selected patients with recurrent malignant glioma, interstitial brachytherapy has been advocated as an effective method for tumor control and prolonged survival. We are presenting our results with brachytherapy in patients with recurrent glioma, and comparing this technique with cytoreductive surgery. Twenty patients (9 male, 11 female) underwent stereotactic I25I implantation for recurrent malignant glioma (9 grade III, 11 grade IV). The average age was 43 years and the average Karnofsky score was 76. All patients had received radiation therapy following their initial surgical procedure and 17 received chemotherapy. The median interval from initial procedure to implantation was 70.5 weeks. The median survival following implantation was 24 weeks and total median survival for the group was 94.5 weeks. This group was compared to a contemporary series of 22 patients (16 male, 6 female) who underwent cytoreductive surgery for malignant glioma (10 grade III, 12 grade IV). The average age was 44 years and the average Karnofsky score was 76. All patients received-radiation therapy following their initial procedure and 20 patients also received chemotherapy. The median interval from initial procedure to second procedure was 35.5 weeks, and from the second procedure to death was 28 weeks. The median survival for the group was 63.5 weeks. The interval from the first procedure to the second procedure was statistically significant comparing the implant group (median 70.5 weeks) versus the cytoreductive surgery group (median 35.5 weeks; p = 0.04). No significant difference could be demonstrated between the interval from second procedure to death in the implant group (median 24 weeks) versus cytoreductive surgery group (median 28 weeks; p = 0.45). Analyzed separately, increasing volume of implanted tumor in the 125I group was associated with a decreased survival (p = 0.002). In this group of unselected patients with recurrent malignant glioma, there was no difference in survival following the second procedure in patients treated either with brachytherapy or cytoreductive surgery. Autopsy series of patients with malignant glioma indicate that diffuse infiltration of the parenchyma occurs. Local therapy may therefore fail to treat this infiltrative component, particularly if given late in the course of the disease. Previous reports of increased survival in patients treated with brachytherapy may reflect the selection criteria for implantation. Patients eligible for implantation have smaller, unifocal, supratentorial lesions away from the midline and fair to good performance status.

Interstitial Brachytherapy versus Cytoreductive Surgery in Recurrent Malignant Glioma

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