title: 12 years' experience with intraoperative radiotherapy (IORT) of malignant gliomas.
abstract: BACKGROUND
  Even after surgery and radiotherapy, malignant gliomas still have a poor prognosis. The authors report on their experience with IORT in 71 patients.
  
  
  METHODS
  From May 1992 to February 2004, 71 patients with malignant gliomas were treated with IORT. 26 patients suffered from grade III gliomas, 45 patients from glioblastomas (GBM). IORT was carried out using a standard electron tube and 9- to 18-MeV electrons. 52/71 patients who were primarily treated received 20 Gy IORT + 60 Gy postoperative radiotherapy, 19/71 patients with recurrences only received IORT (20-25 Gy).
  
  
  RESULTS
  The complication rates were 1.4% for wound infections and 5.6% for hemorrhage. Median disease-specific survival amounted to 14.9 months (gliomas III) and 14.2 months (GBM). The 2-year survival rates amounted to 26.9% (gliomas III) and 6.8% (GBM; p = 0.0296). Total versus subtotal resection had no significant influence on survival (p = 0.0741), nor had age, sex, tumor site, performance status, size, primary versus recurrence, and radiation dose. A comparison to a conventionally treated patient group did not show a significant survival improvement. 3 months after treatment, initial symptoms had improved in 59% (hemiparesis), 50% (aphasia), 50% (hemianopsia), and 60% (convulsions).
  
  
  CONCLUSIONS
  IORT has been shown to be feasible; perioperative complication rates were not increased. Survival was generally not improved compared to a historical control group. Recurrences achieved the same survival as primary tumors, and GBM also had a slightly increased survival, thus being possible indications for IORT.
authors.affiliation: Department of Radiotherapy and Radiation Oncology, University Hospital, Muenster, Germany. pschuel@uni-muenster.de
authors.forename: Patrick
authors.initials: P
authors.lastname: Schueller
authors.forename: Oliver
authors.initials: O
authors.lastname: Micke
authors.forename: Stefan
authors.initials: S
authors.lastname: Palkovic
authors.forename: Johannes
authors.initials: J
authors.lastname: Schroeder
authors.forename: Christos
authors.initials: C
authors.lastname: Moustakis
authors.forename: Frank
authors.initials: F
authors.lastname: Bruns
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuck
authors.forename: Hansdetlef
authors.initials: H
authors.lastname: Wassmann
authors.forename: Normann
authors.initials: N
authors.lastname: Willich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D003627:Data Interpretation, Statistical; D018572:Disease-Free Survival; D004806:Ependymoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D005910:Glioma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D009837:Oligodendroglioma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D011879:Radiotherapy Dosage; D025321:Surgery, Computer-Assisted; D016019:Survival Analysis; D013997:Time Factors