Interstitial brachytherapy procedures for brain tumors

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Abstract
Promising results have been obtained using brachytherapy in the treatment of brain tumors. Very low‐dose rate brachytherapy (60–100 Gy given at 0.05–0.10 Gy/h) has been used for low‐grade gliomas, resulting in 5‐ and 10‐year survival probabilities of 85% and 83% for pilocytic astrocytomas and 61% and 51% for grade II astrocytomas. Only 2.6% of patients had symptomatic radiation necrosis. For faster‐growing high‐grade gliomas, temporary implants delivering about 60 Gy at 0.40–0.60 Gy/h are generally used. The largest series have reported median survival times of 12–13 months after brachytherapy for recurrent malignant gliomas and 18–19 months after diagnosis of primary glioblastomas treated with external beam radiotherapy and brachytherapy boost. A recent prospective, randomized trial demonstrated significantly improved survival for high‐grade glioma patients who had brachytherapy boost. However, over 50% of patients who undergo brachytherapy for malignant gliomas require reoperation for tumor progression and/or radiation necrosis. Strategies are under development to improve local control without increasing radiation toxicity. Semin. Surg. Oncol. 13:157–166, 1997.

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