Table 1.
Outcomes of brachytherapy studies for malignant gliomas
| Trial | No. of patients (P/R) | Histology | Technique | Median dose (Gy) | Median survival (months) | Rate of severe toxicityb (%) | Reoperation rate (%) | |
|---|---|---|---|---|---|---|---|---|
| Temporary BRT | ||||||||
| Gutin et al. 1984 | 31 (R) | GBM (13):AA (18) | 125I + nitrosoureas | 100 | 19 | 12.9 | 16.1 | |
| Gutin et al 1987b | 41 (R) | GBM (18):AA (23) | 125I + EBRT | 88 (BRT) + 60 (EBRT) | 18.5 (GBM only:13; AA only:38.3) | 9.8 | 41 | |
| Gutin et al. 1991 | 63 (P) | GBM (34):AA (29) | 125I + EBRT + procarbazine, lomustine, vincristine | 60 (BRT) + 60 (EBRT) | GBM only:22; AA only:39.3 | 0 | 48 | |
| Scharfen et al. 1992 | 307 (P, R) | GBM (172):AA (135) | 125I + EBRT (primary tumor)/125I (recurrent tumor) | 56 (BRT) + 60 (EBRT) | Primary tumor:GBM only:22,AA only:35.5; recurrent tumor:GBM only:12.3, AA only:13 | 6 | 40 | |
| Zamorano et al. 1992 | 48 (P, R) | GBM:AA | 125I + resection + EBRT | 60 (BRT) + 50 (EBRT) | Primary tumor:15.1; recurrent tumor:10.5 | NA | NA | |
| Bernstein et al. 1994 | 44 (R) | GBM (32):AA (12) | 125I + resection | 70 | 11.5 | 11 | 26 | |
| Chamberlain et al. 1995 | 14 (R) | GBM (10):AA (3):AO (1) | 125I + EBRT + cisplatin | 50 (BRT) + 60 (EBRT) | 9.5 | 7.1 | 64 | |
| Shrieve et al. 1995 | 32 (R) | GBM | 125I + EBRT | 50 (BRT) + NA (EBRT) | 11.5 | 6.3 | 44 | |
| Sneed et al. 1998 | 112 (P) | GBM | 125I + EBRT + oral hydroxyurea ± interstitial hyperthermia | 60 (BRT) + 59.4 (EBRT) | 16.8 (Without hyperthermia:19; with hyperthermia:20) | 5 (Without hyperthermia); 10 (with hyperthermia) | 58 (Without hyperthermia); 69 (with hyperthermia) | |
| Laperriere et al. 1998 a | 63 (P) | GBM | 125I + EBRT | 60 (BRT) + 50 (EBRT) | 15.7 | 4.8 | 31 | |
| Kolotas et al. 1999 | 53 (R) | GBM (31):AA (22) | 192Ir + resection + EBRT | 40 (BRT) + 60 (EBRT) | 8.8 (GBM only:7.3; AA only:13.3) | 17.7 | 0 | |
| Selker et al. 2002 a | 133 (P) | GBM (123):AA (10):AO (3):MMG (1) | 125I + EBRT + BCNU | 60 (BRT) + 60.2 (EBRT) | 17 (GBM only:16) | NA | 54 | |
| Tselis et al. 2007 | 84 (R) | GBM | 192Ir + resection + EBRT | 40 (BRT) + 60 (EBRT) | 9.3 | 3.5 | 0 | |
| Permanent BRT | ||||||||
| Zamorano et al. 1992 | 48 (P, R) | GBM:AA | 125I + resection + EBRT | 110 (BRT) + 50 (EBRT) | Primary tumor:14.6; recurrent tumor:10 | NA | NA | |
| Fernandez et al. 1995 | 58 (P) | GBM (18):AA (40) | 125I + resection + EBRT | 102 (BRT) + 50.4 (EBRT) | >31 (GBM only:>23; AA only:>31) | 10.5 | 45 | |
| Halligan et al. 1996 | 22 (R) | GBM (18):AA (4) | 125I + resection + EBRT | 210 (BRT) + 60 (EBRT) | 16.3 (GBM only:16) | 5 | 0 | |
| Patel et al. 2000 | 40 (R) | GBM | 125I + resection + EBRT | 140 (BRT) + 60 (EBRT) | 11.8 | 7.5 | 0 | |
| Larson et al. 2004 | 38 (R) | GBM | 125I + resection + EBRT | 300 (BRT) + 60 (EBRT) | 13 | 24 | 11 | |
| Glia-site temporary BRT | ||||||||
| Tatter et al. 2003 | 21 (R) | GBM (15):AA (5):AO (1) | 125I + resection + EBRT | 50 (BRT) + NA (EBRT) | 12.7 (GBM only:8; AA only:17.9) | 4.8 | 0 | |
| Chan et al. 2005 | 24 (R) | GBM | 125I + resection | 53.1 | 9.1 | 8 | 8 | |
| Gabayan et al. 2006 | 95 (R) | GBM (80):AA (9):AO (4):MMG (2) | 125I + resection | 60 | 9.1 (GBM only:9; non-GBM only:10.9) | 2 | 2 | |
| Welsh et al. 2007 | 20 (P) | GBM | 125I + resection + EBRT | 50 (BRT) + 60 (EBRT) | 11.4 | 14 | NA | |
P primary tumor, R recurrent tumor, GBM glioblastoma multiforme, AA anaplastic astrocytoma, AO anaplastic oligodendroglioma, MMG malignant mixed glioma, EBRT external beam radiation, NA not available
aProspective randomized studies
bSerious complications defined as hemorrhage, infection, permanent neurological deficit