title: Immediate post-operative brachytherapy prior to irradiation and temozolomide for newly diagnosed glioblastoma.
abstract: To determine whether immediate post-operative brachytherapy can be safely applied to newly diagnosed glioblastomas to retard tumor progression prior to initiation of external beam radiation therapy (EBRT) and temozolomide. Between 1996 and 2011, eleven patients underwent implantation of GliaSite (n = 9) or MammoSite (n = 2) at the time of surgical resection. Brachytherapy was carried out on post-operative day 2-3, with 45-60 Gy delivered to a 1 cm margin. All patients underwent subsequent standard radiation/temozolomide treatment 4-5 weeks post-irradiation. There were no wound related complications. Toxicity was observed in two patients (2/11 or 18 %), including one post-operative seizure and one case of cerebral edema that resolved after a course of steroid treatment. Immediate post-operative and pre-irradiation/temozolomide magnetic resonance imaging assessment was available for 9 of the 11 patients. Two of these nine patients (22 %) developed new regions of contrast enhancement prior to irradiation/temozolomide. This compares favorably to historical data where 53 % of patient suffer such tumor progression. While there was a trend toward improved 6 month progression free survival in the brachytherapy/temozolomide/radiation treated patients, the overall survival of these patients were comparable to historical controls. This case series demonstrates the safety of immediate post-operative brachytherapy when applied prior to EBRT and temozolomide in the treatment of newly diagnosed glioblastomas.
authors.affiliation: Division of Neurosurgery, Center for Theoretic and Applied Neuro-Oncology, University of California, San Diego, 3855 Health Science Drive #0987, La Jolla, CA 92093-0987, USA.
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Waters
authors.forename: Brent
authors.initials: B
authors.lastname: Rose
authors.forename: David D
authors.initials: DD
authors.lastname: Gonda
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scanderbeg
authors.forename: Michelle
authors.initials: M
authors.lastname: Russell
authors.forename: John F
authors.initials: JF
authors.lastname: Alksne
authors.forename: Kevin
authors.initials: K
authors.lastname: Murphy
authors.forename: Bob S
authors.initials: BS
authors.lastname: Carter
authors.forename: Joshua
authors.initials: J
authors.lastname: Lawson
authors.forename: Clark C
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001918:Brachytherapy; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016022:Case-Control Studies; D059186:Chemoradiotherapy, Adjuvant; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D015996:Survival Rate; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide