Regrowth Patterns of Glioblastoma Multiforme Related to Planning of Interstitial Brachytherapy Radiation Fields

Abstract

Recognition of the local nature of glioblastoma has generated an increasing interest in treatment using radioactive implants (interstitial brachytherapy). A key issue in such implantation is the configuration of the radiation field in relation to the resected tumor. In particular, should radiation be provided to the area from which the tumor has been resected? To clarify this issue, we evaluated patterns of tumor regrowth into this resected area in 62 patients. Three patterns of computed tomographic scan-documented tumor regrowth were recognized: preferential (regrowth to refill the resected area only), circumferential (regrowth into the resected area and previously uninvolved contiguous brain) and away (local regrowth into noncontiguous brain, sparing the surgical bed). Regrowth of the tumor 6.3 to 6.8 months after resection was seen in 59 of 62 patients (95.2%). Preferential regrowth was seen in 32 of 62 patients (51.6%), and circumferential regrowth was seen in 27 of 62 patients (43.5%). Regrowth away was seen in 3 of 62 patients (4.8%). Radiation fields planned for interstitial brachytherapy must adequately include the resected area because of the high incidence of tumor regrowth into that area.

Immunotherapy for malignant glioma using human recombinant interleukin-2 and activated autologous lymphocytes

“…Four patients (22.2%) had a glioma develop more than 2 cm from the original tumor site (Away) ( Table 6). These findings generally agree with Bashir et al [80] who reviewed patterns of glioblastoma recurrence in a group of 62 patients although treatment with LAK cells plus rIL-2 may help prevent tumor recurrence at the site of tumor excision and application of immunotherapy. With regards to our other 11 patients, 4 patients, 2 from each group, are alive and have yet to show any evidence of recurrence.…”

Patterns and Timing of Recurrence After Temozolomide-Based Chemoradiation for Glioblastoma

“…Several studies investigating the recurrence patterns after radiation for glioblastoma are summarized in Table 4 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)27). Our study and others (10,21,24) have documented not only initial recurrences but also cumulative recurrences detected on serial MRI scans.…”

“…Although autopsy (4) and stereotactic biopsy (5) studies demonstrate widespread microscopic infiltration within the brain, local recurrence predominates with this disease, most often within 2 cm of the original tumor volume after whole brain radiation (6)(7)(8) or more conformal radiation (9)(10)(11)(12)(13)(14)(15)(16)(17). Conformal radiation to the enhancing tumor and peritumoral edema has become standard.…”

The role of surgery in the management of supratentorial intermediate and high-grade astrocytomas in adults

“…Chang, et al, 33 found a relationship between type of surgery and period of survival in 554 patients entered into a Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group (RTOG/ECOG) protocol conducted between 1974 and 1979. Andreou, et aL, 2 and Wood,et al,~8~ retrospectively analyzed enhanced CT scans of subsets of patients entered into various protocols of the BTSG, and both investigators reported an association between postoperative area of enhancement and survival. Wood, et al, also reported, however, that when preoperative and postoperative studies were compared, the percentage of decrease in the area of enhancement (that is, estimated percentage of tumor resected) was not significantly correlated with survival.…”