Department of Neurosurgery, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Germany.
BMJ Open. 2013 Mar 15;3(3):e002262. doi: 10.1136/bmjopen-2012-002262.
Tumour recurrence of glioblastoma multiforme (GBM) after initial treatment with surgical resection, radiotherapy and chemotherapy is an inevitable phenomenon. This retrospective cohort study compared the efficacy of interstitial high dose rate brachytherapy (HDR-BRT), re-resection and sole dose dense temozolomide chemotherapy (ddTMZ) in the treatment of recurrent glioblastoma after initial surgery and radiochemotherapy.
Retropective cohort study.
Primary level of care with two participating centres. The geographical location was central Germany.
From January 2005 to December 2010, a total of 111 patients developed recurrent GBM after initial surgery and radiotherapy with concomitant temozolomide. The inclusion criteria were as follows: (1) histology-proven diagnosis of primary GBM (WHO grade 4), (2) primary treatment with resection and radiochemotherapy, and (3) tumour recurrence/progression.
This study compared retrospectively the efficacy of interstitial HDR-BRT, re-resection and ddTMZ alone in the treatment of recurrent glioblastoma.
Median survival, progression free survival and complication rate.
Median survival after salvage therapy of the recurrence was 37, 30 and 26 weeks, respectively. The HDR-BRT group did significantly better than both the reoperation (p<0.05) and the ddTMZ groups (p<0.05). Moderate to severe complications in the HDR-BRT, reoperation and sole chemotherapy groups occurred in 5/50 (10%), 4/36 (11%) and 9/25 (36%) cases, respectively.
CT-guided interstitial HDR-BRT attained higher survival benefits in the management of recurrent glioblastoma after initial surgery and radiotherapy with concurrent temozolomide in comparison with the other treatment modalities. The low risk of complications of the HDR-BRT and the fact that it can be delivered percutaneously in local anaesthesia render it a promissing treatment option for selected patients which should be further evaluated.
胶质母细胞瘤（GBM）在初始手术切除、放疗和化疗后复发是不可避免的现象。本回顾性队列研究比较了间质内高剂量率近距离放疗（HDR-BRT）、再次切除和单纯剂量密集替莫唑胺化疗（ddTMZ）治疗初始手术和放化疗后复发性 GBM 的疗效。
回顾性队列研究。
两个参与中心的初级保健水平。地理位置在德国中部。
2005 年 1 月至 2010 年 12 月，共有 111 例患者在初始手术和放疗联合替莫唑胺治疗后发生复发性 GBM。纳入标准如下：（1）组织学证实的原发性 GBM（WHO 分级 4 级）诊断；（2）原发性治疗采用切除术和放化疗；（3）肿瘤复发/进展。
本研究回顾性比较了间质内 HDR-BRT、再次切除和单纯 ddTMZ 单独治疗复发性 GBM 的疗效。
中位生存时间、无进展生存时间和并发症发生率。
挽救治疗后复发的中位生存时间分别为 37、30 和 26 周。HDR-BRT 组明显优于再次手术（p<0.05）和 ddTMZ 组（p<0.05）。HDR-BRT、再次手术和单独化疗组中度至重度并发症分别发生在 5/50（10%）、4/36（11%）和 9/25（36%）的患者中。
与其他治疗方法相比，CT 引导下间质内 HDR-BRT 在初始手术和放疗联合替莫唑胺治疗后复发性 GBM 的管理中获得了更高的生存获益。HDR-BRT 的并发症风险低，并且可以在局部麻醉下经皮进行，这使其成为有选择的患者有前途的治疗选择，应进一步评估。
