Safety and efficacy of concurrent interstitial radiation and hyperthermia in the treatment of progressive malignant brain tumors.
High activity 125I brachytherapy has efficacy in selected recurrent malignant brain tumors, but limited efficacy and risk of radiation necrosis have prompted investigation of additional adjunctive therapies. This study aims to assess the toxicity of interstitial conductive hyperthermia used concurrently with 125I brachytherapy for the treatment of recurrent brain malignancies. Twelve patients with recurrent malignant brain tumors were implanted using afterloading catheters intended to deliver 50 Gy at the isodose line encompassing the enhancing tumor with a 5-mm margin and heated to 41.5 degrees C for 48 h. The average implant volume was 18 cc with 5.3 catheters containing 9.4 sources with a total activity of 265 mCi. Serious toxicities included 8 motor deficits, 2 mood alterations, 4 seizures and 2 catheter wound cerebrospinal fluid leaks. Median survival was 10.35 months with the best responses being 6 with stable disease and 2 with partial responses. Reoperation rate for radiation necrosis was 33%. Concurrent conductive thermoradiotherapy is feasible but is associated with serious toxicity. There is no suggestion of improved survival with thermoradiotherapy over brachytherapy alone. Given the degree of toxicity observed, alternative approaches to improving local control of these tumors are being explored.
Narayan
Prithvi
P
Department of Neurosurgery, Emory University, Atlanta, GA 30322, USA.
Crocker
Ian
I
Elder
Eric
E
Olson
Jeffrey J
JJ
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000009:adverse effects; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D006979:Hyperthermia, Induced; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology