Prados M D, Gutin P H, Phillips T L, Wara W M, Sneed P K, Larson D A, Lamb S A, Ham B, Malec M K, Wilson C B
Department of Neurological Surgery, School of Medicine, University of California, San Francisco.
Int J Radiat Oncol Biol Phys. 1992;24(4):593-7. doi: 10.1016/0360-3016(92)90703-k.
Although interstitial brachytherapy appears to be effective in treating recurrent malignant gliomas, it has been studied less extensively in patients with newly diagnosed tumors. To examine the effect of this treatment when used at the time of primary diagnosis, we retrospectively reviewed the records of 88 patients who received temporary interstitial implants of 125I for newly diagnosed malignant gliomas. This brachytherapy was preceded by a course of external radiation therapy and followed, in some cases, by chemotherapy. The median duration of survival after the beginning of external radiation therapy was 87 weeks in patients with glioblastoma multiforme and 160 weeks in those with anaplastic gliomas. In 46% of patients with glioblastoma multiforme and 56% of those with anaplastic gliomas, a second operation was necessary to remove symptomatic radiation necrosis, recurrent tumor, or both. Our results support the conclusion that interstitial brachytherapy used at the primary diagnosis lengthens survival in selected patients with glioblastoma multiforme. However, the toxicity is significant in terms of the need for surgical resection of symptomatic necrosis. In patients with anaplastic gliomas, the toxicity associated with the treatment probably outweighs its advantages.
尽管间质近距离放射治疗似乎对复发性恶性胶质瘤有效，但在新诊断肿瘤患者中的研究较少。为了研究这种治疗在初次诊断时的效果，我们回顾性分析了88例接受¹²⁵I临时间质植入治疗新诊断恶性胶质瘤患者的记录。这种近距离放射治疗在进行一疗程外照射治疗之前进行，在某些情况下之后进行化疗。多形性胶质母细胞瘤患者外照射治疗开始后的中位生存期为87周，间变性胶质瘤患者为160周。在46%的多形性胶质母细胞瘤患者和56%的间变性胶质瘤患者中，需要进行二次手术以切除有症状的放射性坏死、复发性肿瘤或两者。我们的结果支持这样的结论，即初次诊断时使用间质近距离放射治疗可延长部分多形性胶质母细胞瘤患者的生存期。然而，就有症状坏死需要手术切除而言，毒性是显著的。在间变性胶质瘤患者中，与治疗相关的毒性可能超过其益处。
