Brachytherapy for recurrent malignant astrocytoma.
OBJECTIVE
To assess the efficacy of interstitial brachytherapy in the treatment of patients with recurrent malignant astrocytoma.


METHODS
Forty-six patients with recurrent malignant astrocytoma were treated with stereotactic high-activity temporary iodine-125 implants between September, 1986 and October, 1992. All patients had been initially treated for malignant astrocytoma (44) or low-grade astrocytoma (2) with surgery and external fractionated radiation. The median time between initial diagnosis and recurrence treated with brachytherapy was 12.5 months. Twenty-five patients received chemotherapy prior to brachytherapy.


RESULTS
All but four patients have died; median survival time following brachytherapy is 46 weeks. Twelve patients underwent reoperation for radiation necrosis at a median interval of 6.5 months after treatment (26%). Five patients incurred complications directly due to brachytherapy (11%). Forty-four patients are evaluable regarding pattern of failure following brachytherapy. Six of these 44 patients (13.6%) recurred at a distance from the treatment volume (4 in brain and 2 in spinal subarachnoid space).


CONCLUSIONS
Brachytherapy confers modest but meaningful prolongation of survival in selected patients with recurrent malignant astrocytoma, but complications are significant, reoperation frequently required, and recurrence outside the treatment volume common.
Division of Neurosurgery, Toronto Hospital, Ontario, Canada.
M
M
Bernstein
N
N
Laperriere
J
J
Glen
P
P
Leung
C
C
Thomason
A E
AE
Landon
D000293:Adolescent; D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000401:mortality / Q000532:radiotherapy*; D001918:Brachytherapy / Q000379:methods*; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D002675:Child, Preschool; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D013238:Stereotaxic Techniques; D015996:Survival Rate; D013997:Time Factors
D007457:Iodine Radioisotopes