Fernandez P M, Zamorano L, Yakar D, Gaspar L, Warmelink C
Department of Neurosurgery, Wayne State University, Detroit, Michigan, USA.
Neurosurgery. 1995 Mar;36(3):467-73. doi: 10.1227/00006123-199503000-00004.
Between July 1989 and July 1992, 58 patients with newly diagnosed, histologically confirmed malignant gliomas (40 anaplastic astrocytomas, 18 glioblastoma multiforme) underwent implantation with low-activity iodine-125 sources. Patients were considered appropriate candidates for brachytherapy if their Karnofsky scores were > or = 70 and their contrast-enhancing tumors were < 6 cm in maximum diameter. Tumor volumes ranged from 0.1 to 90 ml. Ten patients had implants only. The other 48 patients received additional external beam radiation; 38 patients received radiation 1 to 2 weeks after the implant, and 10 patients received radiation preceding the implant. Median survival has not been reached but is currently greater than 31 months for patients with anaplastic astrocytoma and greater than 23 months for patients with glioblastoma. The rate of second operation for this group of patients was 45% (26 patients). Brain necrosis requiring resection occurred in 11 patients (19%). Although further follow-up is required, we conclude that low-activity permanent iodine-125 implants provide patients who have newly diagnosed malignant gliomas long-term survival with an acceptable risk of late complications.
在1989年7月至1992年7月期间，58例新诊断的、经组织学确诊的恶性胶质瘤患者（40例间变性星形细胞瘤，18例多形性胶质母细胞瘤）接受了低活度碘-125源植入。如果患者的卡氏评分≥70分且增强扫描的肿瘤最大直径<6 cm，则被认为是近距离放射治疗的合适人选。肿瘤体积为0.1至90 ml。10例患者仅接受了植入。其他48例患者接受了额外的外照射；38例患者在植入后1至2周接受放疗，10例患者在植入前接受放疗。间变性星形细胞瘤患者的中位生存期尚未达到，但目前大于31个月，多形性胶质母细胞瘤患者的中位生存期大于23个月。该组患者的二次手术率为45%（26例患者）。11例患者（19%）发生了需要切除的脑坏死。尽管需要进一步随访，但我们得出结论，低活度永久性碘-125植入可为新诊断的恶性胶质瘤患者提供长期生存，且晚期并发症风险可接受。
