Gutin P H, Leibel S A, Wara W M, Choucair A, Levin V A, Philips T L, Silver P, Da Silva V, Edwards M S, Davis R L
Department of Neurological Surgery, School of Medicine, University of California, San Francisco.
J Neurosurg. 1987 Dec;67(6):864-73. doi: 10.3171/jns.1987.67.6.0864.
The authors report survival data for the first 41 patients treated for recurrent malignant gliomas with interstitial brachytherapy at the University of California, San Francisco (1980-1984). Iodine-125 (125I) sources were temporarily implanted using stereotaxic techniques. The median survival period for 18 patients with recurrent glioblastomas was 52 weeks after brachytherapy; two patients are alive more than 5 years after brachytherapy. The median survival period for 23 patients with recurrent anaplastic astrocytomas is 153 weeks after brachytherapy, with 10 patients alive more than 3 years and four patients alive more than 4 years after brachytherapy. Both groups did significantly better (p less than 0.01) than groups of patients with the same diagnoses and similar general characteristics who were treated at recurrence with chemotherapy alone. Because of deterioration of their clinical condition and evidence of recurrence from computerized tomographic scans, 17 (41%) of 41 patients required reoperation 20 to 72 weeks after brachytherapy. Despite the invariable presence of apparently viable tumor cells mixed with necrotic tissue in the resected specimen, nine patients have survived more than 2 years after reoperation and two of the nine are still alive 4 years after reoperation. The authors conclude that brachytherapy with temporarily implanted 125I sources for well-circumscribed, hemispheric, recurrent malignant gliomas is effective and offers a chance for long-term survival even though focal radiation necrosis can seriously degrade the quality of survival in a minority of patients.
作者报告了1980年至1984年在加利福尼亚大学旧金山分校接受间质近距离放射治疗的41例复发性恶性胶质瘤患者的生存数据。使用立体定向技术临时植入碘-125（125I）源。18例复发性胶质母细胞瘤患者近距离放射治疗后的中位生存期为52周；两名患者在近距离放射治疗后存活超过5年。23例复发性间变性星形细胞瘤患者近距离放射治疗后的中位生存期为153周，10例患者在近距离放射治疗后存活超过3年，4例患者存活超过4年。这两组患者的情况均明显优于（p<0.01）那些具有相同诊断和相似一般特征、复发时仅接受化疗的患者组。由于临床状况恶化以及计算机断层扫描显示复发迹象，41例患者中有17例（41%）在近距离放射治疗后20至72周需要再次手术。尽管在切除标本中总是存在与坏死组织混合的明显存活肿瘤细胞，但9例患者在再次手术后存活超过2年，其中9例中有2例在再次手术后4年仍然存活。作者得出结论，对于边界清楚、位于半球的复发性恶性胶质瘤，采用临时植入125I源的近距离放射治疗是有效的，即使局灶性放射性坏死会严重降低少数患者的生存质量，但仍为长期生存提供了机会。
