Randomized study of brachytherapy in the initial management of patients with malignant astrocytoma

被引:201
作者
Laperriere, NJ
Leung, PMK
McKenzie, S
Milosevic, M
Wong, S
Glen, J
Pintilie, M
Bernstein, M
机构
[1] Princess Margaret Hosp, Dept Radiat Oncol, Toronto, ON M5G 2M9, Canada
[2] Princess Margaret Hosp, Dept Clin Phys, Toronto, ON, Canada
[3] Princess Margaret Hosp, Dept Biostat, Toronto, ON, Canada
[4] Univ Toronto, Toronto Hosp, Div Neurosurg, Toronto, ON, Canada
[5] Univ Toronto, Toronto Hosp, Div Neurol, Toronto, ON, Canada
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 1998年 / 41卷 / 05期
关键词
glioblastoma multiforme; brachytherapy; randomized study; prognostic factors;
D O I
10.1016/S0360-3016(98)00159-X
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: A randomized study was undertaken to assess the role of brachytherapy as a boost to external beam radiation therapy in the initial management of patients with malignant astrocytomas. Methods and Materials: Inclusion criteria included the following: biopsy-proven supratentorial malignant astrocytoma of brain less than or equal to 6 cm in size, not crossing midline or involving corpus callosum, age 18-70, Karnofsky Performance Status (KPS) greater than or equal to 70. Patients were randomized to external radiation therapy only delivering 50 Gray (Gy) in 25 fractions over 5 weeks or external radiation therapy plus a temporary stereotactic iodine-125 implants delivering a minimum peripheral tumor dose of 60 Gy, Patients were stratified to age less than or equal to 50 or >50, and KPS greater than or equal to 90 or less than or equal to 80. Results: There were 140 patients randomized between 1986 and 1996, 71 to the implant arm and 69 to external irradiation only. Pathologically 125 patients had necrosis noted in their tumor specimen. Factors associated with improved survival in univariate analysis were age less than or equal to 50, KPS greater than or equal to 90, chemotherapy at recurrence, and reoperation at the original tumor site. The Cox proportional hazards model revealed the following significant factors: treatment at recurrence (chemotherapy or reoperation) with a relative risk (RR) of 0.6 (p = 0.004) and KPS greater than or equal to 90 with a RR 0.6 (p = 0.007), Randomization to the implant arm was associated with a RR of 0.7 (p = 0.07), Median survival for patients randomized to brachytherapy or not were 13.8 vs. 13.2 months, respectively, p = 0.49, Conclusions: We conclude that stereotactic radiation implants have not demonstrated a statistically significant improvement in survival in the initial management of patients with malignant astrocytoma. (C) 1998 Elsevier Science Inc.
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收藏
页码:1005 / 1011
页数:7
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