High-Dose-Rate Brachytherapy for Poor-Prognosis, High-Grade Glioma: (Phase II) Preliminary Results

Abstract

The short course of brachytherapy provides a good palliation in terms of functional improvement in a high proportion of patients, with low and acceptable toxicity.

Interstitial high-dose-rate brachytherapy in the primary treatment of inoperable glioblastoma multiforme

“…Treatment was well tolerated, with fatigue and alopecia grade II being the most frequently observed adverse events. To this end, data concerning the value of BRT in the primary RT treatment of inoperable GBM are sparse [10,11,13,14] (Table 3). Julow et al .…”

“…In a phase II study, Micheletti et al . [13] reported on 17 patients with inoperable high-grade gliomas undergoing primary HDR BRT. Interstitial RT was performed twice daily, with a single dose of either 5.0 Gy or 3.85 Gy over 5 or 7 fractions, respectively.…”

“…In inoperable patients that are clinically eligible for treatment, external beam radiotherapy (EBRT) [3], systemic chemotherapy (CHT) [4], or a combination of both [5,6,7] are the most common utilized modalities prolonging survival up to 14 months. While the role of interstitial (IRT) brachytherapy (BRT) in the treatment of high-grade gliomas has been studied in the adjuvant [8] and recurrence setting [9], there are very few data concerning its implementation in the primary treatment of inoperable GBM [10,11,12,13,14]. In the present single-institute analysis, we report our experience with computed tomography (CT)-guided high-dose rate (HDR) BRT in the primary treatment of inoperable GBM in the pre-temozolomide (TMZ) era.…”

Controversies concerning the application of brachytherapy in central nervous system tumors

“…This may account for the lower rate (6%) of moderate to severe complications in HDR studies (Tselis et al 2007), compared to up to 26% in LDR studies and even higher when BRT was combined with hyperthermia (Table 1) (Bernstein et al 1994;Halligan et al 1996;Patel et al 2000;Shrieve et al 1995;Sneed et al 1992). Additionally, HDR techniques can palliate patients with non-resectable lesions or poor functional scores without external beam radiation (EBRT), in order to reduce the overall hospitalization and (Micheletti et al 1994(Micheletti et al , 1996 The authors concluded that together with decreased total treatment time (<7 days), the overall survival was equal or better than comparable patients received EBRT Micheletti et al 1994Micheletti et al , 1996.…”

“…Initially, BRT for malignant gliomas is performed after the completion of EBRT or at the time of disease recurrence; however, several recent studies have explored the administration of BRT as upfront treatment at the time of diagnosis prior to EBRT (Micheletti et al 1994(Micheletti et al , 1996. Use of cytoreductive procedures prior to initiating treatment is the underlying rationale supported widely, though this rationale itself remains questionable with its beneWt elusive from the literature for aggressive surgical resections (Lacroix et al 2001;Simpson et al 1993).…”