Department of Neurosurgery, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
Neuro Oncol. 2011 Oct;13(10):1133-42. doi: 10.1093/neuonc/nor100. Epub 2011 Aug 25.
The purpose of this study was to assess the impact of stereotactic brachytherapy (SBT) on survival time and outcome when applied after resection of low-grade glioma (LGG) of World Health Organization grade II. From January 1982 through December 2006 we treated 1024 patients who had glioma with stereotactic implantation of iodine-125 seeds and SBT in accordance with a prospective protocol. For the present analysis, we selected 95 of 277 patients with LGG, in whom SBT was applied to treat progressive (43 patients) or recurrent (52 patients) tumor after resection. At 24 months after seed implantation, the tumor response rate was 35.9%, and the tumor control rate was 97.3%. The median progression-free-survival (PFS) duration after SBT was 52.7 ± 7.1 months. Five-year and 10-year PFS probabilities were 43.4% and 10.7%, respectively. Malignant tumor transformation, the diagnosis "astrocytoma," and tumor volume >20 mL were significantly associated with reduced PFS. Tumor progression or relapse after SBT (53 of 95 patients) was treated with tumor resection, a second SBT, chemotherapy, and/or radiotherapy. The median overall survival duration (from the first diagnosis of LGG until the patient's last contact) was 245.0 ± 4.9 months. Patients still under observation after seed implantation had a median follow-up time of 156.4 ± 55.7 months. Perioperative transient morbidity was 1.1%, and the frequency of permanent morbidity caused by SBT was 3.3%. In conclusion, SBT of recurrent or progressive LGG after resection located in functionally critical brain areas has high local efficacy and comparably low morbidity. Referred to individually adopted glioma treatment concepts SBT provides a reasonably long PFS, thus improving overall survival. In selected patients, SBT can lead to delays in the application of chemotherapy and/or radiotherapy.
本研究旨在评估在切除低级别胶质瘤（LGG）后应用立体定向近距离放疗（SBT）对生存时间和结果的影响。我们自 1982 年 1 月至 2006 年 12 月，按照前瞻性方案，用碘-125 种子立体定向植入和 SBT 治疗了 1024 名患有脑肿瘤的患者。在本分析中，我们从 277 名 LGG 患者中选择了 95 名患者，这些患者在切除后应用 SBT 治疗进展性（43 例）或复发性（52 例）肿瘤。在种子植入后 24 个月，肿瘤反应率为 35.9%，肿瘤控制率为 97.3%。SBT 后无进展生存（PFS）时间的中位数为 52.7±7.1 个月。5 年和 10 年的 PFS 概率分别为 43.4%和 10.7%。恶性肿瘤转化、诊断为“星形细胞瘤”以及肿瘤体积＞20ml 与 PFS 降低显著相关。SBT 后肿瘤进展或复发（95 例患者中有 53 例）采用肿瘤切除术、第二次 SBT、化疗和/或放疗治疗。从 LGG 首次诊断到患者最后一次随访的总生存时间中位数为 245.0±4.9 个月。接受种子植入后仍在观察中的患者中位随访时间为 156.4±55.7 个月。围手术期短暂发病率为 1.1%，SBT 引起的永久性发病率为 3.3%。总之，切除后位于功能关键脑区的复发性或进展性 LGG 的 SBT 具有较高的局部疗效和相对较低的发病率。SBT 是根据个别采用的胶质瘤治疗概念进行的，可提供合理长的 PFS，从而提高总生存率。在选择的患者中，SBT 可能导致化疗和/或放疗的延迟应用。
