Scharfen C O, Sneed P K, Wara W M, Larson D A, Phillips T L, Prados M D, Weaver K A, Malec M, Acord P, Lamborn K R
Department of Radiation Oncology, University of California, San Francisco 94143-0226.
Int J Radiat Oncol Biol Phys. 1992;24(4):583-91. doi: 10.1016/0360-3016(92)90702-j.
A total of 307 adult patients with glioma were treated with high-activity removable iodine-125 interstitial brain implants at the University of California at San Francisco from December 1979 to June 1990. Recurrent gliomas underwent brain implant alone whereas previously untreated (primary) tumors underwent brain implant boost after external beam radiotherapy. Of these patients, 106 had primary glioblastoma multiforme, 68 had primary non-glioblastoma glioma, 66 had recurrent glioblastoma multiforme and 67 had recurrent nonglioblastoma glioma. Median follow-up for living patients was 143 weeks. Median survival from diagnosis for primary glioblastoma multiforme and high and low grade nonglioblastoma glioma was 88 weeks, 142 weeks, and 226 weeks, respectively. Median survival measured from the date of implant for recurrent glioblastoma multiforme and high and low grade nonglioblastoma glioma was 49 weeks, 52 weeks, and 81 weeks, respectively. Ninety-two percent of patients had no toxicity or transient acute side effects. Severe acute toxicity was seen in 6% of patients, life threatening acute toxicity in 1% of patients, and fatal toxicity in less than 1% of patients. Forty percent of patients with malignant glioma underwent reoperation at a median of 33 weeks after brain implant, with tumor found in 95% of specimens at reoperation. This large experience demonstrates that interstitial implant is well-tolerated and prolongs survival in patients with primary and recurrent glioblastoma multiforme, as evidenced by the 3-year survival rates of 22% and 15%, respectively.
1979年12月至1990年6月期间，加利福尼亚大学旧金山分校对总共307例成年胶质瘤患者进行了高活性可移除碘 - 125脑间质植入治疗。复发性胶质瘤仅接受脑植入治疗，而先前未接受治疗的（原发性）肿瘤在体外照射放疗后接受脑植入强化治疗。在这些患者中，106例患有原发性多形性胶质母细胞瘤，68例患有原发性非胶质母细胞瘤性胶质瘤，66例患有复发性多形性胶质母细胞瘤，67例患有复发性非胶质母细胞瘤性胶质瘤。存活患者的中位随访时间为143周。原发性多形性胶质母细胞瘤以及高级别和低级别非胶质母细胞瘤性胶质瘤从诊断开始的中位生存期分别为88周、142周和226周。复发性多形性胶质母细胞瘤以及高级别和低级别非胶质母细胞瘤性胶质瘤从植入日期开始测量的中位生存期分别为49周、52周和81周。92%的患者无毒性或仅有短暂的急性副作用。6%的患者出现严重急性毒性，1%的患者出现危及生命的急性毒性，不到1%的患者出现致命毒性。40%的恶性胶质瘤患者在脑植入后中位33周接受了再次手术，再次手术时95%的标本中发现有肿瘤。这项大规模研究表明，脑间质植入耐受性良好，可延长原发性和复发性多形性胶质母细胞瘤患者的生存期，原发性和复发性多形性胶质母细胞瘤患者的3年生存率分别为22%和15%，这一结果证明了这一点。
