Abstract
BACKGROUND: Despite several advances in the management of malignant glioma, treatment options in case of tumor recurrence after multimodal treatment are limited. The present study reports feasibility and outcome of low-dose rate stereotactic brachytherapy (SBT) with iodine 125 seeds in a patient cohort with inoperable circumscribed recurrent WHO III or IV gliomas. METHODS: Patients with either an anaplastic glioma or glioblastoma who received SBT in case of a tumor recurrence were retrospectively analyzed. SBT was performed according to a prospective protocol established since 1990 at our institution* using iodine-125 seeds for low dose rate implantation. Tumor recurrence was verified histologically prior to seed implantation in all patients. Survival analysis was performed using Cox-regression models to identify prognostic factors for post-recurrence survival (PRS). RESULTS: A total number of 227 patients (83 WHO III and 144 WHO IV) were included. Median follow-up time was 132.2 months. Age at implantation was 49.5 years, Karnofsky performance score (KPS) was 80%, tumor surface dose was 60 Gy and the tumor volume was 17.8 cm3 (median). Median PRS was 14.0 (CI95% 12.4-15.7) months in the entire group; 28.0 (CI 95% 20.2.-35.9) months for WHO III and 11.3 (CI95% 8.8-12.9) months for WHO IV tumors (log rank p <0.0001). In the Cox regression analysis, variables associated with improved PRS following SBT were WHO III histology (p <0.0001), lower age (p = 0.004), higher KPS (p = 0.0017) and lower seed activity (p = 0.027). No permanent morbidity occurred; transient morbidity was observed in 6.9 % of all patients. CONCLUSIONS: In patients with a circumscribed high grade glioma recurrence following multimodal therapy, SBT is a safe and effective therapy option permitting further salvage therapies. *institution of affiliation Nr. 2
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