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Low-dose rate stereotactic iodine-125 brachytherapy for the treatment of inoperable primary and recurrent glioblastoma: single-center experience with 201 cases

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Abstract

Treatment options for inoperable glioblastoma are limited. Low-dose-rate stereotactic iodine-125 brachytherapy (SBT) has been reported as an effective and low-risk treatment option for circumscribed low-grade gliomas and brain metastases. The present study evaluates this treatment approach for patients with inoperable glioblastoma. Between 1990 and 2012, 201 patients with histologically proven glioblastoma were treated with SBT (iodine-125 seeds; median cumulative surface dose, 60 Gy; median dose-rate, 6 cGy/h; median gross-tumor-volume, 17 ml) either as primary treatment (n = 103) or at recurrence (n = 98). In addition to SBT, 90.3 % of patients in the primary treatment group received external boost radiotherapy (median dose, 25.2 Gy). Adjuvant chemotherapy was added for 30.8 % of patients following SBT and consisted of temozolomide for the majority of cases (88.7 %). Procedure-related complications, clinical outcome, progression-free and overall survival (PFS, OS) were evaluated. Median follow-up was 9.8 months. The procedure-related mortality was zero. During follow-up, transient and permanent procedure-related morbidity was observed in 7.5 and 2.0 %, respectively. Calculated from the time of SBT, median OS and PFS rates were 10.5 and 6.2 months, with no significant differences among primary and recurrent tumors (11.1 vs.10.4 months for OS and 6.2 vs. 5.9 months for PFS). For OS, multivariate analysis revealed Karnofsky performance score, age, and adjuvant chemotherapy as independent prognostic factors (all p < 0.01). Low-dose-rate SBT is a relatively safe and potentially effective local treatment option for patients with circumscribed inoperable glioblastoma initially or at recurrence. It deserves prospective validation since it may improve the outcome for a subset of patients with inoperable GBM.

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Acknowledgments

We would like to thank Volker Sturm for establishing the prospective treatment protocol and for treating numerous patients together with Ralph Lehrke and. Mohammad Maarouf.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Stereotactic and Functional Neurosurgery, University Clinics of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    Philipp Kickingereder, Veerle Visser-Vandewalle, Harald Treuer & Maximilian I. Ruge

  2. Department of General Neurosurgery, University Hospital of Cologne, Cologne, Germany

    Christina Hamisch & Roland Goldbrunner

  3. Department of Neurosurgery, Ludwig Maximilians University of Munich, Munich, Germany

    Bogdana Suchorska

  4. Department of Neurology, University Hospital of Cologne, Cologne, Germany

    Norbert Galldiks

  5. Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany

    Norbert Galldiks

  6. Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany

    Martin Kocher

  7. Department of Stereotactic Neurosurgery, University Hospital of Magdeburg, Magdeburg, Germany

    Juergen Voges

  8. Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany

    Christina Hamisch, Norbert Galldiks, Veerle Visser-Vandewalle, Roland Goldbrunner, Martin Kocher, Harald Treuer & Maximilian I. Ruge

  9. Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany

    Philipp Kickingereder

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  1. Philipp Kickingereder
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  10. Maximilian I. Ruge
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Correspondence to Maximilian I. Ruge.

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Philipp Kickingereder, Christina Hamisch have contributed equally to this article.

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Kickingereder, P., Hamisch, C., Suchorska, B. et al. Low-dose rate stereotactic iodine-125 brachytherapy for the treatment of inoperable primary and recurrent glioblastoma: single-center experience with 201 cases. J Neurooncol 120, 615–623 (2014). https://doi.org/10.1007/s11060-014-1595-y

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