Prospective comparative study of intraoperative balloon electronic brachytherapy versus resection with multidisciplinary adjuvant therapy for recurrent glioblastoma

Abstract

Background: Intraoperative balloon electronic brachytherapy (IBEB) may provide potential benefit for local control of recurrent cerebral glioblastomas (GBMs). Methods: This is a preliminary report of an open-label, prospective, comparative cohort study conducted in two neurosurgical centers with ongoing follow-up. At recurrence, patients at one center (n = 15) underwent reresection with IBEB while, at the second center (n = 15), control subjects underwent re-resection with various accepted second-line adjuvant chemoradiotherapy options. A comparative analysis of overall survival (OS) and local progression-free survival (LPFS) following re-resection was performed. Exploratory subgroup analysis based on postoperative residual contrast-enhanced volume status was also done. Results: In the IBEB group, median LPFS after re-resection was significantly longer than in the control group (8.0 vs. 6.0 months; log rank χ2 = 4.93, P = 0.026, P < 0.05). In addition, the median OS after second resection in the IBEB group was also significantly longer than in the control group (11.0 vs. 8.0 months; log rank χ2 = 4.23, P = 0.04, P < 0.05). Conclusion: These hypothesis-generating results from a small cohort of subjects suggest putative clinical benefit in OS and LPFS associated with maximal safe re-resection of recurrent GBM with IBEB versus re-resection and standard adjuvant therapy, a hypothesis that deserves further testing in an appropriately powered clinical trial.

Preclinical Studies with Glioblastoma Brain Organoid Co-Cultures Show Efficient 5-ALA Photodynamic Therapy

“…Of particular interest would be to determine the ability of the tumor to respond to local therapies, which could become part of the neurosurgical resources [ 30 , 31 , 32 , 33 , 34 ]. Organoids could inform of both the antitumorigenic effect of these therapies and the potential collateral damage to the surrounding brain tissue.…”

Editorial: Modern neurosurgical management of gliomas, including local therapies

“…Positive results have been recently reported by a group including the author of this Editorial ( 9 ), using a system locally implemented into the surgical cavity at the end of the tumor removal procedure, with the aim of delivering a precisely calculated high radiation dosage targeted mostly at the edge of the surgical cavity wall where presumably scattered tumor cells are left in situ despite apparent macroscopic tumor removal. In this study, the survival of GBM patients treated with such a protocol was significantly longer than that of patients undergoing routine post-operative chemoradiotherapy, while in at the same time, radionecrosis sequelae were limited.…”

“…Currently, surgery represents a major instrument in the hands of clinicians in for helping these unfortunate patients. In fact, it is well known that apparent radical surgery is a key factor for prolonging post-operative patients' survival [(5,6), Ren et al (7,8)], in as well as reoperative surgery patients (3,9). This the necessitates of searching for any possible means in to increase the chances of achieving an apparent surgical radical excision in demanding cases, such as tumors located in critical areas and/or deeply situated in the brain, as well as in recurrent tumors.…”

“…In fact, it is well known that apparent radical surgery is a key factor for prolonging post-operative patients’ survival [( 5 , 6 ), Ren et al. ( 7 , 8 )], in as well as reoperative surgery patients ( 3 , 9 ).…”

Erratum: Prospective comparative study of intraoperative balloon electronic brachytherapy versus resection with multidisciplinary adjuvant therapy for recurrent glioblastoma

“…In the article entitled “ Prospective comparative study of intraoperative balloon electronic brachytherapy versus resection with multidisciplinary adjuvant therapy for recurrent glioblastoma ” published in Surgical Neurology International [ 1 ] there are the following figure legend corrections: Figure 3 legend is incorrectly written as Kaplan-Meier curves for overall survival in the intraoperative balloon electronic brachytherapy group stratified according to postoperative residual contrast-enhanced volume (PCEV): the subgroup of subjects with PCEV >2.5 cm 3 marked in red, the subgroup of subjects with PCEV ≤2.5 cm 3 marked in green; log rank χ2 = 8.03, P = 0.005, P < 0.05 instead of Kaplan-Meier curves for overall survival in the intraoperative balloon electronic brachytherapy group stratified according to postoperative residual contrast-enhanced volume (PCEV): the subgroup of subjects with PCEV >2.5 cm 3 marked in green, the subgroup of subjects with PCEV ≤2.5 cm 3 marked in red; log rank c 2 = 8.03, P = 0.005, P < 0.05. Figure 4 legend is incorrectly written as Kaplan-Meier curves for overall survival: The intraoperative balloon electronic brachytherapy group marked in green, the control group marked in red; Log Rank c 2 = 4.23, P = 0.04, P < 0.05 instead of Kaplan-Meier curves for overall survival: The intraoperative balloon electronic brachytherapy group marked in red, the control group marked in green; Log Rank c 2 = 4.23, P = 0.04, P < 0.05.…”