title: High-dose-rate stereotactic brachytherapy for patients with newly diagnosed glioblastoma multiformes.
abstract: OBJECTIVE
  To evaluate high-dose-rate (HDR) stereotactic brachytherapy (STBT) for glioblastoma multiforme (GBM).
  
  
  METHODS
  Between August 1994 and December 1998, 28 patients with newly diagnosed GBM underwent surgery, external-beam radiotherapy (EBRT) and HDR STBT. STBT eligibility criteria included unifocal lesions, residual tumor < or = 6 cm in maximum diameter, supratentorial lesions, tumors not crossing the midline, tumors without subependymal spread and Karnofsky performance status (KPS) > 60. STBT was delivered over five consecutive days with two fractions per day for a total median dose of 30 Gy. Twenty-eight STBT eligible GBM patients treated with surgery and EBRT only over the same period were matched controls.
  
  
  RESULTS
  Median survival times for the STBT group and controls were 19.5 versus 12.5 months; one and two year survival rates were 89% versus 42% and 61% versus 28%, respectively (p = 0.12). Using multivariate analysis, age, KPS and HDR STBT were significant factors predicting survival. By RPA class, 2-year survival rates for STBT and controls were: III--78% versus 50%; IV--40% versus 0%; V--21% versus 15%, respectively. Corresponding median survival times in months were: 41.6 versus 21.2 (p = 0.39); 16.7 versus 12.1 (p = 0.36); 18.7 versus 10.6 (p = 0.02). No major complications were found in the STBT arm.
  
  
  CONCLUSIONS
  Because of small patient numbers, median survival time increases were only statistically significant in the RPA Class V patients, but a strong survival time trend emerged favoring patients undergoing HDR STBT. Further prospective study is warranted to fully assess the merits of this technique for GBM management.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, LinKou, Taiwan, ROC.
authors.forename: Chen-Nen
authors.initials: CN
authors.lastname: Chang
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Chen
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Wei
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.forename: Yat-Sen
authors.initials: YS
authors.lastname: Ho
authors.forename: David Ying-Chung
authors.initials: DY
authors.lastname: Huang
authors.forename: Steve Pai-Hsun
authors.initials: SP
authors.lastname: Lee
authors.forename: Ji-Hong
authors.initials: JH
authors.lastname: Hong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D015996:Survival Rate; D016896:Treatment Outcome