SURVIVAL AND QUALITY OF LIFE AFTER INTERSTITIAL IMPLANTATION OF REMOVABLE HIGH-ACTIVITY I-125 SOURCES FOR THE TREATMENT OF PATIENTS WITH RECURRENT MALIGNANT GLIOMAS
SURVIVAL AND QUALITY OF LIFE AFTER INTERSTITIAL IMPLANTATION OF REMOVABLE HIGH-ACTIVITY I-125 SOURCES FOR THE TREATMENT OF PATIENTS WITH RECURRENT MALIGNANT GLIOMAS
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DOI：
10.1016/0360-3016(89)90518-x
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发表时间：
1989-12-01
影响因子：
7
通讯作者：
PHILLIPS, TL
中科院分区：
文献类型：
--
作者：
LEIBEL, SA;GUTIN, PH;PHILLIPS, TL
1980年1月至1988年1月，95例可评价的复发性、单灶性、幕上恶性胶质瘤患者接受了高活度碘-125源经后装可拆卸导管直接植入肿瘤内的再次放射治疗。肿瘤剂量为5270-15,000 cGY，距离CT扫描显示的对比度增强的肿块边缘最远0.5厘米。50例间变性星形细胞瘤的中位生存期为81周，45例多形性胶质母细胞瘤的中位生存期为54周。间变性星形细胞瘤的18和36个月生存率分别为46%和28%，多形性胶质母细胞瘤的18和36个月生存率分别为22%和8%。由于临床恶化，激素依赖性增加，CT扫描显示种植部位的肿块效应增加，47例(49%)患者在开颅手术中切除了坏死组织，部分患者肿瘤与坏死组织混合。再次手术的患者与未接受此手术的患者相比，生存时间明显延长。卡氏评分(KPS)连续测定显示，植入后即刻6个月内，患者组整体情况无明显恶化。在18个月时，33名患者存活；KPS在50到90之间(平均79分)，67%的患者依赖类固醇。在36个月时，18名患者存活；17名患者的KPS评分在40-90之间(平均76分)，53%的患者依赖类固醇。在17名可评估的长期幸存者中，有11人的KPS为80或更高，平均为87分。间质内近距离放射治疗可为复发性恶性胶质瘤患者提供长期存活期，这些患者以前曾接受过常规远距离放射治疗。大多数长期幸存者的生活质量似乎相当令人满意。使用这种方式控制肿瘤生长的进一步尝试似乎是有必要的。
Between January 1980 and January 1988, 95 evaluable patients with recurrent, unifocal, supratentorial malignant gliomas were reirradiated with high-activity iodine-125 sources implanted directly into tumor in afterloaded, removable catheters using computerized tomography-directed stereotaxy. A tumor dose of 5270-15,000 cGy was delivered at a maximum distance of 0.5 cm from the rim of the contrast-enhancing mass seen on CT scans. The median survival for the 50 patients with anaplastic astrocytoma was 81 weeks and for 45 patients with glioblastoma multiforme it was 54 weeks. The 18- and 36-month survival rates for patients with anaplastic astrocytoma were 46% and 28%, respectively; the 18- and 36-month survival rates for patients with glioblastoma multiforme were 22% and 8%, respectively. Because of clinical deterioration, increasing steroid dependency, and increasing mass effect at the implantation site seen on CT scans, necrotic tissue was excised from 47 patients (49%) at craniotomy; in some patients, tumor was mixed with necrotic tissue. The survival of reoperated patients was significantly longer compared with patients who did not undergo this procedure. Serial determination of the Karnofsky Performance Score (KPS) showed that there was no significant deterioration for the group as a whole during the 6 months immediately after implantation. At 18 months, 33 of the patients were alive; KPS ranged between 50 to 90 (mean 79) and 67% were steroid dependent. At 36 months, 18 patients were alive; 17 patients were evaluable with KPS that ranged between 40 to 90 (mean 76) and 53% were steroid dependent. Eleven of the 17 evaluable long-term survivors had a KPS of 80 or higher with a mean of 87. Interstitial brachytherapy may provide long-term survival in selected patients with recurrent malignant gliomas who have been irradiated previously with conventional teletherapy. The quality of life in the majority of long-term survivors appears to be quite satisfactory. Further attempts to control tumor growth using this modality appear to be warranted.