Zamorano L, Yakar D, Dujovny M, Sheehan M, Kim J
Department of Neurosurgery, Wayne State University, Mich.
Stereotact Funct Neurosurg. 1992;59(1-4):183-92. doi: 10.1159/000098940.
Survival data of 114 patients treated for malignant brain tumors with 125I interstitial radiation therapy at Henry Ford Hospital, Detroit, Mich. (1986-1990), are presented. The first 64 patients were treated with temporary 125I implants with a total prescribed dose of 60 Gy at a dose rate of 40 cGy/h. In order to reduce the risk of injury to the surrounding normal tissue associated with high-dose brachytherapy, a new approach was initiated using permanent implants with a lower dose rate; 50 patients were treated after surgical resection with permanent implantation of 125I seeds at a lower dose rate of 4-7 cGy/h, with a total dose of 10,000-12,000 cGy, and concurrent external radiation therapy of 5,000 cGy. The rationale of this protocol was to increase the effectiveness of the low-dose-rate implant by a concurrent 'daily' boost of external radiation, thus inhibiting the proliferation of tumor cells during the protracted low-dose radiation treatment. Survival was compared between groups with permanent and temporary implants in terms of effectiveness in tumor control as well as impact on clinical condition. Low-dose-rate implant with concurrent external radiation therapy seems to offer the best chance for long-term survival without deterioration in the clinical condition.
本文呈现了1986年至1990年期间在密歇根州底特律市亨利·福特医院接受¹²⁵I组织间放射治疗的114例恶性脑肿瘤患者的生存数据。前64例患者接受临时¹²⁵I植入治疗，总处方剂量为60 Gy，剂量率为40 cGy/h。为降低与高剂量近距离放射治疗相关的周围正常组织损伤风险，开始采用一种新方法，即使用低剂量率的永久性植入物；50例患者在手术切除后接受永久性¹²⁵I粒子植入，剂量率为4 - 7 cGy/h，总剂量为10,000 - 12,000 cGy，并同时进行5,000 cGy的外照射治疗。该方案的基本原理是通过同时进行“每日”外照射增强来提高低剂量率植入物的有效性，从而在长时间低剂量放射治疗期间抑制肿瘤细胞的增殖。比较了永久性和临时性植入物两组在肿瘤控制效果以及对临床状况影响方面的生存率。低剂量率植入物联合外照射治疗似乎为长期生存且不使临床状况恶化提供了最佳机会。
