Long term results of stereotactic brachytherapy used in the initial treatment of patients with glioblastomas

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Abstract
Background. Despite optimal therapy with surgery and radiotherapy, the prognosis of patients with glioblastomas remains poor. Stereotactic brachytherapy involves the accurate placement of radioactive isotopes within brain tumors, significantly increasing the dose of radiation that can be delivered to the tumor bed without substantial risk to surrounding normal tissue, potentially improving local tumor control and patient survival. Methods. Between February 1987 and July 1993, the authors treated 56 patients with glioblastomas with stereotactic brachytherapy as part of their initial therapy. Patients underwent surgery, limited field external beam radiotherapy, and brachytherapy with temporary high‐activity iodine 125 sources, giving an additional 50 Gy to the tumor bed. Results. Median survival for patients undergoing brachytherapy was 18 months compared with 11 months for a matched brachytherapy control group with similar clinical and radiologic features (P ≤ 0.0007). Survival rates at 1, 2, and 3 years after diagnosis of 83%, 34%, and 27%, respectively, for patients receiving brachytherapy were significantly increased compared with survival rates of 40%, 12.5%, and 9%, respectively, for control subjects. Thirty‐six patients (64%) underwent reoperation for symptomatic radiation necrosis from 3 to 42 months (median, 11 months) after brachytherapy. The median survival of patients undergoing reoperation was 22 months compared with 13 months for those who did not have further surgery (P ≤ 0.02). Thirty‐five percent of patients relapsed locally within the brachytherapy target volume, whereas 65% had marginal or distant relapses. Conclusions. Brachytherapy may improve local tumor control and prolong survival when used in the initial treatment of selected patients with glioblastomas. Cancer 1994; 73:3029–36.