This study reports the initial experience at the University of California San Francisco (UCSF) with
tumor resection and permanent, low-activity
iodine 125 (125I)
brachytherapy in patients with progressive or recurrent
glioblastoma multiforme (GM) and compares these results to those of similar patients treated previously at UCSF with temporary
brachytherapy without
tumor resection. Thirty-eight patients with progressive or recurrent GM were treated at UCSF with repeat
craniotomy,
tumor resection, and permanent, low-activity 125I
brachytherapy between June 1997 and May 1998. Selection criteria were Karnofsky performance score > or =60, unifocal, contrast-enhancing, well-circumscribed progressive or recurrent GM that was judged to be completely resectable, and no evidence of leptomeningeal or subependymal spread. The median
brachytherapy dose 5 mm exterior to the resection cavity was 300 Gy (range, 150-500 Gy). One patient was excluded from analysis. Median survival was 52 weeks from the date of
brachytherapy. Age, Karnofsky performance score, and preimplant
tumor volume were all statistically significant on univariate analyses. Multivariate analysis for survival showed only age to be significant. Median time to progression was 16 weeks. Both univariate and multivariate analysis of freedom from progression showed only preoperative
tumor volume to be significant. Comparison to temporary
brachytherapy patients showed no apparent difference in survival time. Chronic
steroid requirements were low in patients with minimal postoperative
residual tumor. We conclude that permanent 125I
brachytherapy for recurrent or progressive GM is well tolerated. Survival time was comparable to that of a similar group of patients treated with temporary
brachytherapy.