Table 3.
Prospective randomized brachytherapy studies for primary malignant gliomas
| Trial | Laperriere et al. 1998 | Selker et al. 2002 |
|---|---|---|
| Technique | 125I + EBRT vs. EBRT | 125I + EBRT + BCNU vs. EBRT + BCNU |
| No. of patients | 71b vs. 69 | 133 vs. 137 |
| KPS | 70–100 | 50–100 |
| Histology | GBM | GBM (123):AA (10):AO (3):MMG (1) |
| Tumor size/median (cm3) | 2.5–158/42.3 | 1–117/21 |
| Isotope (T/P) | 125I (T) | 125I (T) |
| Total dose (median, Gy) | 57.22–67.69 (60) | 60 |
| Dose rate (median, Gy/h) | 0.21–1.25 (0.7) | 0.4 |
| Adjuvant therapy | EBRT (50 Gy) | EBRT (60.2 Gy) + BCNU (1,500 mg/m2, intravenously) |
| Extent of resection | ||
| Subtotal resection | 51 | 21 |
| Partial resection | 70 | 210 |
| Biopsy | 19 | 39 |
| Median survival (weeks) | 62.8 vs. 52.8 | 68.1 (GBM only:64.0) vs. 58.8 |
| Necrosis in specimen (%) | 65(92) vs. 60(87) | 11 (15) vs. 15 (23) |
| Rate of severe toxicity related to implanta (%) | 4.8 | NA |
| Reoperation rate (%) | 31 vs. 33 | 54 vs. 47 |
| Favorable prognostic factors | Age ≤50, KPS ≥90, chemotherapy at recurrence, reoperation at the original tumor site | Age ≤54, KPS ≥70, non-GBM histology, male |
| Recurrence patterns (%) | ||
| Original site | 82 vs. 93 | NA |
| Original site + multifocal | 7 vs. 0 | NA |
| Alive at last observation (%) | 8.5 vs. 5.8 | NA |
T temporary implant, P permanent implant, GBM glioblastoma multiforme, AA anaplastic astrocytoma, AO anaplastic oligodendroglioma, MMG malignant mixed glioma, EBRT external beam radiation, NA not available
aSerious complications defined as hemorrhage, infection, permanent neurological deficit
bOnly 63 of 71 patients actually received implant