title: [Intraoperative radiotherapy (IORT) in malignant brain tumors].
abstract: OBJECTIVE
  Feasibility and morbidity of IORT for malignant brain tumors as well as value of innovative imaging for diagnosis of rest tumors and recurrences were examined.
  
  
  METHODS
  Between May 1992 and November 1993, 23 patients with malignant brain tumors were treated in Münster with IORT. The patient collective was heterogeneous and negatively selected, i.e. beside of primary treatments, also patients with extensive previous treatment, recurrent tumors or metastases were included. Therapy consisted of radical surgical resection and intraoperative electron radiotherapy using total doses from 15 Gy to 25 Gy relative to the 90% isodose. Afterwards, patients without prior treatment underwent percutaneous irradiation with a maximum dose of 60 Gy, related to the small volume of the tumor area plus a safety margin of 2 cm.
  
  
  RESULTS
  No increase of peri-operative morbidity or subacute sequelae was observed. Overall 1-year survival was 67% for grade III gliomas (WHO), and 56% for glioblastoma multiforme. When the Matsutani selection criteria (primary therapy of a supratentorial, peripheral astrocytoma grade III or glioblastoma smaller than 5 cm in diameter with a Karnofsky performance index of more than 60% and possible wide resection) were applied, 1-year survival increased to 75%. Nuclear medical diagnostics using 123I-alpha-methyltyrosin SPECT proved a valuable method for imaging of non-resectable tumor tissue and diagnosis of recurrences.
  
  
  CONCLUSIONS
  The results of this study indicate that IORT can contribute to successful tumor treatment while neither increasing peri-operative morbidity nor subacute sequelae.
authors.affiliation: Klinik und Poliklinik für Strahlentherapie--Radioonkologie, Westfälischen Wilhelms-Universität Münster.
authors.forename: W
authors.initials: W
authors.lastname: Wagner
authors.forename: P
authors.initials: P
authors.lastname: Schüller
authors.forename: N
authors.initials: N
authors.lastname: Willich
authors.forename: O
authors.initials: O
authors.lastname: Schober
authors.forename: S
authors.initials: S
authors.lastname: Palkovic
authors.forename: C
authors.initials: C
authors.lastname: Morgenroth
authors.forename: P
authors.initials: P
authors.lastname: Bartenstein
authors.forename: F J
authors.initials: FJ
authors.lastname: Prott
authors.forename: U
authors.initials: U
authors.lastname: Niewöhner
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery*; D004806:Ependymoma / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000532:radiotherapy / Q000601:surgery; D005910:Glioma / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008545:Melanoma / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D009837:Oligodendroglioma / Q000532:radiotherapy / Q000601:surgery; D010865:Pilot Projects; D011182:Postoperative Care; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed