title: First Experience of Intraoperative Radiation Therapy in Cerebral High Grade Glioma in Iran: A Report of Three Cases and Literature Review.
abstract: BACKGROUND
  Among the high grade cerebral gliomas, Glioblastoma multiform for instance, would be the main pattern of local recurrence causes clinical deterioration and deaths. This has observed 2 - 3 cm upon the initial lesion. During the period of 2 - 4 weeks post-surgery, remaining tumor cells have re-grown until radiochemotherapy has initiated. So it has seemed clear that improved local control could hopefully translate into improved survival. As a matter of fact, mass reduction has insufficiently achieved in almost every case of GBM as that the tumor cell number has not fallen below a "threshold" that tumor control might achieve by the host immune system. Intraoperative Radiation therapy has been one of those add-on therapies, which has performed during or directly after resection and cleared the tumor cavity from microscopically remaining cells. Although IORT has presented a novel and feasible principle, the method faced a number of technical and geometrical errors and limitations, which has decreased its potential in the reports of previous studies. Examples could be mentioned as incomplete target volume coverage that seemed as the greatest influence on survival, due to irradiation with an inadequate electron cone size, due to angle errors, or inadequately low energies. In contrast to the previously used forward-beaming electron cones, spherical irradiation sources were specifically attractive in brain tumor IORT, even in post resection cavities with normal complex shapes.
  
  
  METHODS
  We have been reporting 3 cases of high grade gliomas, one recurrent GBM, one primary glioma grade III, and the last one recurrent Rhabdoid GBM, which have been fulfilling our entrance criteria of IORT procedure, by using spherical applicators, which has been increasingly discussed in recent studies.
  
  
  CONCLUSIONS
  It was the first experience of intraoperative radiation therapy for cerebral malignant tumours in Iran. Finally, we had a brief overview on the past and present IORT strategies in the treatment of GBM.
authors.affiliation: Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
authors.forename: Afsoun
authors.initials: A
authors.lastname: Seddighi
authors.affiliation: Cancer Research Centre (CRC), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Esmaeil Akbari
authors.affiliation: Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
authors.forename: Amir Saied
authors.initials: AS
authors.lastname: Seddighi
authors.affiliation: Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
authors.forename: Afshin
authors.initials: A
authors.lastname: Rakhsha
authors.affiliation: Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
authors.forename: Marjan
authors.initials: M
authors.lastname: Vaezi
authors.affiliation: Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
authors.forename: Amir Hossein
authors.initials: AH
authors.lastname: Zohrevand
keywords: Glioblastoma Multiform; Glioma; High Grade; Intraoperative; Radiation Therapy