Interstitial brachytherapy procedures for brain tumors.
Promising results have been obtained using brachytherapy in the treatment of brain tumors. Very low-dose rate brachytherapy (60-100 Gy given at 0.05-0.10 Gy/h) has been used for low-grade gliomas, resulting in 5- and 10-year survival probabilities of 85% and 83% for pilocytic astrocytomas and 61% and 51% for grade II astrocytomas. Only 2.6% of patients had symptomatic radiation necrosis. For faster-growing high-grade gliomas, temporary implants delivering about 60 Gy at 0.40-0.60 Gy/h are generally used. The largest series have reported median survival times of 12-13 months after brachytherapy for recurrent malignant gliomas and 18-19 months after diagnosis of primary glioblastomas treated with external beam radiotherapy and brachytherapy boost. A recent prospective, randomized trial demonstrated significantly improved survival for high-grade glioma patients who had brachytherapy boost. However, over 50% of patients who undergo brachytherapy for malignant gliomas require reoperation for tumor progression and/or radiation necrosis. Strategies are under development to improve local control without increasing radiation toxicity.
Sneed
P K
PK
Department of Radiation Oncology, University of California, San Francisco 94143-0226, USA.
McDermott
M W
MW
Gutin
P H
PH
D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005909:Glioblastoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005910:Glioma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D011829:Radiation Dosage; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate