Sneed P K, Stauffer P R, Gutin P H, Phillips T L, Suen S, Weaver K A, Lamb S A, Ham B, Prados M D, Larson D A
Department of Radiation Oncology, University of California, San Francisco.
Neurosurgery. 1991 Feb;28(2):206-15. doi: 10.1097/00006123-199102000-00006.
Between June 1987 and June 1989, 29 recurrent malignant gliomas or recurrent solitary brain metastases in 28 patients were treated in a Phase I study of interstitial irradiation and hyperthermia. Patient age ranged from 18 to 65 years, and the Karnofsky Performance Status scores ranged from 40 to 90%. There were 13 glioblastomas, 10 anaplastic astrocytomas, 3 melanomas, and 3 adenocarcinomas. Catheters were implanted stereotactically after computed tomography-based preplanning. Hyperthermia was administered before and after brachytherapy, using one to six 2450- or 915-MHz helical coil microwave antennas and one to three multisensor fiberoptic thermometry probes. The goal was to heat as much of the tumor as possible to 42.5 degrees C for 30 minutes. Within 30 minutes after the first hyperthermia treatment, implant catheters were afterloaded with high-activity iodine-125 seeds delivering tumor doses of 32.6 to 61.0 Gy. Most patients had no sensation of heating. Complications included seizures in 5 patients, reversible neurological changes in 9 patients, a scalp burn in 1, and infections in 3. Of 28 evaluable 2-month follow-up scans, 11 showed definite improvement in the radiological appearance of the tumor, 4 were slightly improved, 7 were stable, and 6 showed tumor progression. Ten patients underwent reoperation for persistent tumor and/or necrosis. Eleven of 28 patients are alive 40 to 97 weeks after treatment. Thirteen patients died of a brain tumor, 2 died of extracranial melanoma metastases, 1 died of new brain melanoma metastases, and 1 died of a pulmonary embolus. The median survival was 55 weeks overall. Median survival has not yet been reached for the anaplastic astrocytoma subgroup. We conclude that interstitial brain hyperthermia using helical coil microwave antennas is technically feasible. The level of toxicity is acceptable, and the computed tomographic response rate is encouraging.
在1987年6月至1989年6月期间，对28例患者的29例复发性恶性胶质瘤或复发性孤立性脑转移瘤进行了一项间质照射和热疗的I期研究。患者年龄在18至65岁之间，卡氏功能状态评分在40%至90%之间。其中有13例胶质母细胞瘤、10例间变性星形细胞瘤、3例黑色素瘤和3例腺癌。在基于计算机断层扫描的术前规划后，通过立体定向植入导管。在近距离放射治疗前后进行热疗，使用一至六个2450或915兆赫兹的螺旋线圈微波天线和一至三个多传感器光纤测温探头。目标是将尽可能多的肿瘤加热到42.5摄氏度并持续30分钟。在第一次热疗治疗后30分钟内，将高活性碘-125种子源装入植入导管，给予肿瘤32.6至61.0戈瑞的剂量。大多数患者没有热感。并发症包括5例患者发生癫痫、9例患者出现可逆性神经改变、1例头皮烧伤和3例感染。在28例可评估的2个月随访扫描中，11例显示肿瘤的放射学表现有明确改善，4例略有改善，7例稳定，6例显示肿瘤进展。10例患者因持续性肿瘤和/或坏死接受了再次手术。28例患者中有11例在治疗后40至97周仍存活。13例患者死于脑肿瘤，2例死于颅外黑色素瘤转移，1例死于新的脑黑色素瘤转移，1例死于肺栓塞。总体中位生存期为55周。间变性星形细胞瘤亚组的中位生存期尚未达到。我们得出结论，使用螺旋线圈微波天线进行间质脑热疗在技术上是可行的。毒性水平是可接受的，计算机断层扫描反应率令人鼓舞。
