Siddiqi S N, Provias J, Laperriere N, Bernstein M
Division of Neurosurgery, Toronto Hospital, Ontario, Canada.
Neurosurgery. 1997 May;40(5):910-7; discussion 917-8. doi: 10.1097/00006123-199705000-00005.
To determine the effect of initial therapy (surgery and external beam radiation) on the proliferative capacity of glioblastoma and whether adjunctive high focused doses of radiation therapy can further reduce the proliferative capacity of the tumor. This would provide a rationale for attempting to further control local tumor growth with the different forms of high-dose focused radiation available.
Patients with glioblastoma were initially treated within a randomized, controlled study with or without iodine-125 (125 I) brachytherapy after initial surgical resection and external beam radiation (50 Gy in 25 fractions). Specimens from 24 consecutive patients later reoperated for "recurrence" were used to determine the effects of 125 I brachytherapy on the histological features and proliferating cell nuclear antigen index of the tumor tissue.
125 I brachytherapy reduced histological features prognostic for tumor progression, i.e., cellularity, pleomorphism, vessel hyperplasia, and degree of mitosis (P < 0.05). The degree of mitosis (marker for the mitotic or "M" phase) and proliferating cell nuclear antigen index (market for the late G1 and S phase) provide complementary data on the cell kinetics of the tumor. Proliferating cell nuclear antigen immunostaining was lower in the 125 I brachytherapy group (34.6 +/- 8.2%, mean +/- standard error) compared with the control nonimplant group (68.2 +/- 3.5%). 125 I brachytherapy produced a dramatic reduction in mitotic figures (mean histological score = 0.0 +/- 0.0).
Adjunctive treatment of glioblastoma with discrete high doses of radiation therapy delivered by 125 I brachytherapy allows further control of the proliferative capacity of the tumor.
确定初始治疗（手术和外照射放疗）对胶质母细胞瘤增殖能力的影响，以及辅助性高聚焦剂量放疗是否能进一步降低肿瘤的增殖能力。这将为尝试利用不同形式的高剂量聚焦放疗进一步控制局部肿瘤生长提供理论依据。
胶质母细胞瘤患者在初次手术切除和外照射放疗（25次分割，共50 Gy）后，在一项随机对照研究中接受或不接受碘-125（¹²⁵I）近距离放疗。对24例随后因“复发”再次手术的连续患者的标本进行分析，以确定¹²⁵I近距离放疗对肿瘤组织组织学特征和增殖细胞核抗原指数的影响。
¹²⁵I近距离放疗降低了肿瘤进展的预后组织学特征，即细胞密度、多形性、血管增生和有丝分裂程度（P < 0.05）。有丝分裂程度（有丝分裂或“M”期标志物）和增殖细胞核抗原指数（晚G1期和S期标志物）提供了关于肿瘤细胞动力学的补充数据。¹²⁵I近距离放疗组的增殖细胞核抗原免疫染色低于对照非植入组（34.6 +/- 8.2%，平均值 +/- 标准误），而对照非植入组为（68.2 +/- 3.5%）。¹²⁵I近距离放疗使有丝分裂图像显著减少（平均组织学评分 = 0.0 +/- 0.0）。
¹²⁵I近距离放疗给予的离散高剂量放疗辅助治疗胶质母细胞瘤可进一步控制肿瘤的增殖能力。
