title: Treatment of recurrent high-grade gliomas  with GliaSite brachytherapy: a prospective mono-institutional Italian experience.
abstract: OBJECTIVE
  The present study evaluated toxicity, local control, and survival in patients with relapsed high-grade glioma after surgery and external beam radiation therapy and treated with re-operation and GliaSite brachytherapy.
  
  
  METHODS
  Between 2006 and 2008, 15 patients with recurrent high-grade glioma underwent re-operation and GliaSite brachytherapy. Ten patients were males and 5 females. Median age was 40 years (range, 20-71). Karnofsky performance status was ≥70. All patients but one received GliaSite irradiation of the surgical cavity wall at the dose of 4500 cGy at a depth of 1 cm.
  
  
  RESULTS
  No severe acute side effects were observed during GliaSite brachytherapy. Pathologically documented, symptomatic late radiation necrosis was observed in 3 patients (20%); 2 subsequently died of further complications. Two patients were alive at a median follow-up 13 months (range, 1-30). Median overall survival after GliaSite brachytherapy was 13 months.
  
  
  CONCLUSIONS
  Patients with recurrent high-grade glioma can be treated with additional surgery and GliaSite brachytherapy, delivering 4500 cGy at 1 cm depth without significant acute side effects but with a significant rate (20%) of late radiation necrosis, resulting in 13% of treatment-related deaths. Compared with the literature, survival results in our study appear to be satisfactory, but they may be related to patient selection criteria. Re-intervention followed by GliaSite brachytherapy should not be offered as a standard treatment for recurrent high-grade glioma, because of the high rate of late complications, treatment-related deaths, and high treatment costs.
authors.affiliation: Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy. cgobitti@cro.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Gobitti
authors.forename: Eugenio
authors.initials: E
authors.lastname: Borsatti
authors.forename: Mauro
authors.initials: M
authors.lastname: Arcicasa
authors.forename: Mario
authors.initials: M
authors.lastname: Roncadin
authors.forename: Giovanni
authors.initials: G
authors.lastname: Franchin
authors.forename: Emilio
authors.initials: E
authors.lastname: Minatel
authors.forename: Miran
authors.initials: M
authors.lastname: Skrap
authors.forename: Bruno
authors.initials: B
authors.lastname: Zanotti
authors.forename: Francesco
authors.initials: F
authors.lastname: Tuniz
authors.forename: Marino
authors.initials: M
authors.lastname: Cimitan
authors.forename: Elvira
authors.initials: E
authors.lastname: Capra
authors.forename: Annalisa
authors.initials: A
authors.lastname: Drigo
authors.forename: Mauro G
authors.initials: MG
authors.lastname: Trovò
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001918:Brachytherapy / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005910:Glioma / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents