Schnell O, Schöller K, Ruge M, Siefert A, Tonn J-C, Kreth F W
Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany.
J Neurol. 2008 Oct;255(10):1495-502. doi: 10.1007/s00415-008-0948-x. Epub 2008 Jul 25.
The current pilot study analyzed feasibility, risk and effectiveness of 1) microsurgery plus stereotactic iodine-125 ((125)I) brachytherapy (SBT) for large (diameter > 4 cm), circumscribed, and complex located WHO grade II glioma and 2) SBT alone for small (diameter < 4 cm), and complex located recurrences.
Lowactivity temporary (125)I seeds were used. The applied reference dose was 54 Gy and the dose rate was low (median, 10 cGy/h). Time to progression and time to additional external beam radiation (EBR) and/or chemotherapy were estimated with the Kaplan-Meier method. Any adverse sequel potentially attributable to treatment was classified as morbidity. Treatment effects of SBT were estimated according to the modified MacDonald criteria.
Thirtyone patients (de novo group: n = 18, recurrence group: n = 13) were included. The median tumor volume before surgery was 66 ml. A planned partial tumor resection achieved eligibility for SBT in all patients. Transient morbidity of microsurgery and SBT was 27.8 % and 6.4 %, respectively. There was no permanent morbidity. Radiogenic complications did not occur. Complete response, partial response, and stable disease were seen in 8, 9, and 14 patients, respectively. Ten patients exhibited tumor progression (overall 5-year progression- free survival > 60 %). The 5-year probability to receive chemotherapy and/or EBR was 18 %.
A planned partial tumor resection of large and complex located WHO grade II glioma is safe. SBT of small and complex located residual of recurrent tumors is safe and minimally invasive. Combined treatment may provide the possibility to withhold EBR and/or chemotherapy for a considerable number of patients and deserves further prospective evaluation.
当前的初步研究分析了以下两种治疗方法的可行性、风险及有效性：1）显微手术联合立体定向碘-125（¹²⁵I）近距离放射治疗（SBT）用于治疗直径大于4 cm、边界清晰且位置复杂的世界卫生组织（WHO）二级胶质瘤；2）单独使用SBT治疗直径小于4 cm且位置复杂的复发性肿瘤。
使用低活度临时¹²⁵I种子源。应用的参考剂量为54 Gy，剂量率较低（中位数为10 cGy/h）。采用Kaplan-Meier法估计疾病进展时间以及接受额外外照射放疗（EBR）和/或化疗的时间。任何可能归因于治疗的不良后遗症均归类为并发症。根据改良的MacDonald标准评估SBT的治疗效果。
纳入31例患者（初发组：n = 18，复发组：n = 13）。术前肿瘤体积中位数为66 ml。计划进行的部分肿瘤切除术使所有患者符合SBT治疗条件。显微手术和SBT的短暂并发症发生率分别为27.8%和6.4%。无永久性并发症。未发生放射性并发症。分别有8例、9例和14例患者出现完全缓解、部分缓解和病情稳定。10例患者出现肿瘤进展（总体5年无进展生存率>60%）。接受化疗和/或EBR的5年概率为18%。
对于位置大且复杂的WHO二级胶质瘤，计划进行的部分肿瘤切除术是安全的。对于位置小且复杂的复发性肿瘤残留，SBT安全且微创。联合治疗可能使相当一部分患者无需接受EBR和/或化疗，值得进一步进行前瞻性评估。
