Wen P Y, Alexander E, Black P M, Fine H A, Riese N, Levin J M, Coleman C N, Loeffler J S
Brain Tumor Center of Brigham and Women's Hospital, Boston, MA 02115.
Cancer. 1994 Jun 15;73(12):3029-36. doi: 10.1002/1097-0142(19940615)73:12<3029::aid-cncr2820731222>3.0.co;2-4.
Despite optimal therapy with surgery and radiotherapy, the prognosis of patients with glioblastomas remains poor. Stereotactic brachytherapy involves the accurate placement of radioactive isotopes within brain tumors, significantly increasing the dose of radiation that can be delivered to the tumor bed without substantial risk to surrounding normal tissue, potentially improving local tumor control and patient survival.
Between February 1987 and July 1993, the authors treated 56 patients with glioblastomas with stereotactic brachytherapy as part of their initial therapy. Patients underwent surgery, limited field external beam radiotherapy, and brachytherapy with temporary high-activity iodine 125 sources, giving an additional 50 Gy to the tumor bed.
Median survival for patients undergoing brachytherapy was 18 months compared with 11 months for a matched brachytherapy control group with similar clinical and radiologic features (P < 0.0007). Survival rates at 1, 2, and 3 years after diagnosis of 83%, 34%, and 27%, respectively, for patients receiving brachytherapy were significantly increased compared with survival rates of 40%, 12.5%, and 9%, respectively, for control subjects. Thirty-six patients (64%) underwent reoperation for symptomatic radiation necrosis from 3 to 42 months (median, 11 months) after brachytherapy. The median survival of patients undergoing reoperation was 22 months compared with 13 months for those who did not have further surgery (P < 0.02). Thirty-five percent of patients relapsed locally within the brachytherapy target volume, whereas 65% had marginal or distant relapses.
Brachytherapy may improve local tumor control and prolong survival when used in the initial treatment of selected patients with glioblastomas.
尽管采用手术和放疗等最佳治疗方法，胶质母细胞瘤患者的预后仍然很差。立体定向近距离放射治疗涉及将放射性同位素精确放置在脑肿瘤内，可显著增加输送到肿瘤床的辐射剂量，而对周围正常组织没有实质性风险，有可能改善局部肿瘤控制和患者生存率。
1987年2月至1993年7月期间，作者对56例胶质母细胞瘤患者采用立体定向近距离放射治疗作为初始治疗的一部分。患者接受了手术、有限野体外照射放疗以及使用临时高活性碘125源进行的近距离放射治疗，使肿瘤床额外接受50 Gy的辐射。
接受近距离放射治疗的患者中位生存期为18个月，而具有相似临床和放射学特征的配对近距离放射治疗对照组患者的中位生存期为11个月（P < 0.0007）。接受近距离放射治疗的患者在诊断后1年、2年和3年的生存率分别为83%、%和27%，与对照组患者分别为40%、12.5%和9%的生存率相比显著提高。36例患者（64%）在近距离放射治疗后3至42个月（中位时间为11个月）因放射性坏死症状接受了再次手术。接受再次手术的患者中位生存期为22个月，而未进行进一步手术的患者中位生存期为13个月（P < 0.02）。35%的患者在近距离放射治疗靶区内局部复发，而65%的患者有边缘或远处复发。
近距离放射治疗用于部分选定的胶质母细胞瘤患者的初始治疗时，可能改善局部肿瘤控制并延长生存期。
