Treatment of recurrent glioblastoma multiforme with gliasite brachytherapy
Treatment of recurrent glioblastoma multiforme with gliasite brachytherapy
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DOI：
10.1016/j.ijrobp.2004.12.032
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发表时间：
2005-07-15
影响因子：
7
通讯作者：
Kleinberg, L
中科院分区：
文献类型：
--
作者：
Chan, TA;Weingart, JD;Kleinberg, L
目的：在本研究中，我们评估GliaSite近距离放射治疗复发性多形性胶质母细胞瘤（GBM）患者的疗效。方法和材料：1999年至2004年间，24例复发性多形性胶质母细胞瘤患者接受了GliaSite放射治疗系统（RTS）的治疗。GliaSite是一种充气球囊导管，在手术切除时放置在切除腔内。然后用有机结合的1251 (Iotrex [3-(I-125)-碘-4-羟基苯磺酸钠]的水溶液暂时给气球充气，在局部进行低剂量率的辐射。约翰霍普金斯医院的复发性GBM患者，先前接受过手术和外束放疗，手术切除后进行GliaSite球囊植入。随后，患者接受GliaSite放射治疗，平均剂量为53.1 Gy。男性10例，女性14例。平均年龄48.1岁。所有患者病理证实为复发性GBM。Karnofsky性能状态（KPS）中位数为80。中位随访时间为21.8个月。结果：分析时，18例（75%）患者死亡；6例（25%）患者存活。所有患者诊断后的中位生存期为23.3个月。GliaSite近距离治疗后的中位生存期为9.1个月。KPS >= 70的患者中位生存期为9.3个月，而KPS < 70的患者中位生存期为3.1个月（p < 0.003）。接受45戈瑞的患者和接受剂量大于45戈瑞的患者的生存率无显著差异。急性副作用轻微，包括轻度恶心和/或头痛。一名患者出现伤口感染。未发现脑膜炎病例。晚期后遗症罕见，但有2例出现症状性放射性坏死。1例患者出现短暂性表达性失语。结论：与复发性GBM的历史对照组相比，GliaSite放疗可延长复发性多形性胶质母细胞瘤患者的生存期。在KPS >= 70的患者中，GliaSite治疗的生存期为9.3个月，而KPS < 70的患者仅为3.1个月。在每个递归划分分析类中，观察到患者的良好生存率。使用GliaSite治疗是安全的，通常耐受性良好。需要更多的数据来充分评估GliaSite近距离治疗复发性GBM的治疗效果。(c) 2005爱思唯尔公司
Purpose: In this study, we assess the efficacy of GliaSite brachytherapy in the treatment of patients with recurrent glioblastoma multiforme (GBM).Methods and Materials: Between 1999 and 2004, 24 patients with recurrent glioblastoma multiforme were treated with the GliaSite Radiation Therapy System (RTS). The GliaSite is an inflatable balloon catheter that is placed in the resection cavity at the time of surgical resection. Low-dose-rate radiation is then delivered locally by temporarily inflating the balloon with an aqueous solution of organically bound 1251 (Iotrex [sodium 3-(I-125)-iodo-4-hydroxybenzenesulfonate]). Patients at the Johns Hopkins Hospital with recurrent GBM, who were previously treated with surgery and external beam radiotherapy, underwent surgical resection followed by GliaSite balloon implantation. Subsequently, the patients received radiation therapy using the GliaSite to a mean dose of 53.1 Gy. Ten patients were male, and 14 patients were female. The mean age was 48.1 years. All patients had pathologically confirmed recurrent GBM. The median Karnofsky performance status (KPS) was 80. Median follow-up time was 21.8 months.Results: At the time of analysis, 18 patients (75%) had died; 6 patients (25%) were alive. Median survival from diagnosis for all patients was 23.3 months. Median survival after GliaSite brachytherapy was 9.1 months. Patients with a KPS >= 70 had a median survival of 9.3 months, whereas patients with a KPS < 70 had a median survival of 3.1 months (p < 0.003). Survival was not significantly different between patients receiving 45 Gy and patients receiving a dose greater than 45 Gy. Acute side effects were minor, consisting of mild nausea and/or headache. One patient developed a wound infection. No incidents of meningitis were observed. Late sequelae were rare, but 2 incidents of symptomatic radiation necrosis were observed. One patient developed transient expressive aphasia.Conclusions: GliaSite radiotherapy confers a prolongation of survival in patients with recurrent glioblastoma multiforme compared to historical controls with recurrent GBM. GliaSite therapy leads to a favorable survival outcome of 9.3 months in patients with KPS >= 70, but only 3.1 months in patients with KPS < 70. Favorable survival is observed for patients within each recursive partitioning analysis class. Treatment with GliaSite is safe and generally well tolerated. Additional data are needed to fully assess the therapeutic benefit of GliaSite brachytherapy for recurrent GBM. (c) 2005 Elsevier Inc.