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CT-guided interstitial HDR-brachytherapy for recurrent glioblastoma multiforme: a 20-year single-institute experience

CT-gestützte interstitielle HDR-Brachytherapie bei rezidiviertem Gliobastoma multiforme: 20 Jahre monozentrischer Erfahrung

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Abstract

Purpose

To report our results of computed tomography-guided interstitial high-dose-rate (HDR) brachytherapy (BRT) in the treatment of patients with recurrent inoperable glioblastoma multiforme (GBM).

Patients and methods

Between 1995 and 2014, 135 patients were treated with interstitial HDR BRT for inoperable recurrent GBM located within previously irradiated volumes. Patient’s median age was 57.1 years (14–82 years). All patients were pretreated with surgery, postoperative external beam radiation therapy (EBRT) and systemic chemotherapy (ChT). The median recurrent tumor volume was 42 cm3 (2–207 cm3). The prescribed HDR dose was median 40 Gy (30–50 Gy) delivered in twice-daily fractions of 5.0 Gy over consecutive days. No repeat surgery or ChT was administered in conjunction with BRT. Survival from BRT, progression-free survival (PFS), toxicity as well as the impact of several prognostic factors were evaluated.

Results

At a median follow-up of 9.2 months, the median overall survival following BRT and the median PFS were 9.2 and 4.6 months, respectively. Of the prognostic variables evaluated in univariate analysis, extent of surgery at initial diagnosis, tumor volume at recurrence, as well as time from EBRT to BRT reached statistical significance, retained also in multivariate analysis. Eight patients (5.9%) developed treatment-associated complications including intracerebral bleeding in 4 patients (2.9%), symptomatic focal radionecrosis in 3 patients (2.2%), and severe convulsion in 1 patient (0.7%).

Conclusions

For patients with recurrent GBM, interstitial HDR BRT is an effective re-irradiation method for even larger tumors providing palliation without excessive toxicity.

Zusammenfassung

Ziel

Vorstellung der CT(Computertomographie)-gestützten interstitiellen HDR(„high dose rate“)-Brachytherapie (BRT) zur Behandlung inoperabler GBM(Glioblastoma-multiforme)-Rezidive.

Patienten und Methoden

Von 1995–2014 wurden insgesamt 135 Patienten mit inoperablen GBM-Rezidiven mittels interstitieller BRT rebestrahlt. Das mediane Patientenalter betrug 57,1 Jahre (14–82 Jahre). Alle Patienten waren voroperiert und hatten im Rahmen ihrer Primärbehandlung eine adjuvante Radiochemotherapie erhalten. In der Rezidivsituation betrug das mediane Tumorvolumen 42 cm3 (2–207 cm3). Die Rebestrahlung erfolgte als fraktionierte interstitielle HDR-BRT mit einer medianen Gesamtdosis von 40 Gy (30–50 Gy), appliziert in 2‑mal täglichen Fraktionsdosen zu jeweils 5 Gy über aufeinander folgende Tage. Kein Patient erhielt eine simultane Chemotherapie oder eine erneute Resektion nach BRT. Evaluiert wurden das Überleben nach BRT, das Progressionsfreie Überleben, das Toxizitätsprofil sowie der Einfluss prognostischer Faktoren.

Ergebnisse

Bei einer medianen Nachbeobachtungszeit von 9,2 Monaten betrugen das mediane Überleben nach BRT und das mediane progressionsfreie Überleben jeweils 9,2 und 4,6 Monate. Als statistisch signifikant hinsichtlich der evaluierten prognostischen Faktoren erwiesen sich das Resektionsausmaß bei der Primärbehandlung, das Tumorvolumen in der Rezidivsituation und die Zeit zwischen adjuvanter Radiotherapie und BRT sowohl in der univariaten als auch in der multivariaten Analyse. Acht (5,9 %) therapieassoziierte Komplikationen wurden verzeichnet: intrakranielle Blutungen bei 4 (2,9 %), symptomatische Radionekrosen in 3 (2,2 %) und schwere konvulsive Episoden bei einem (0,7 %) Patienten.

Schlussfolgerung

Die CT-gestützte interstitielle HDR-BRT ist eine sichere Methode für die Rebestrahlung insbesondere größerer GBM-Rezidive, die ohne exzessive Toxizität Palliation bieten kann.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Georgios Chatzikonstantinou, Nikolaos Zamboglou, Claus Rödel & Nikolaos Tselis

  2. German Oncology Center, Limassol, Cyprus

    Nikolaos Zamboglou

  3. Department of Neurosurgery, University Hospital Mainz, Johannes Gutenberg University, Mainz, Germany

    Eleftherios Archavlis

  4. Department of Radiation Oncology, University Hospital Freiburg, Albert-Ludwigs University, Freiburg im Breisgau, Germany

    Iosif Strouthos

  5. Department of Radiation Oncology, Offenbach Hospital, Offenbach am Main, Germany

    Eleni Zoga

  6. Division of Medical Physics and Engineering, Offenbach Hospital, Offenbach am Main, Germany

    Natasha Milickovic

  7. Department of Radiation Medicine, New York Medical College, New York, NY, USA

    Basil Hilaris

  8. Division of Medical Physics, University Hospital Freiburg, Albert-Ludwigs University, Freiburg im Breisgau, Germany

    Dimos Baltas

Authors
  1. Georgios Chatzikonstantinou
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  2. Nikolaos Zamboglou
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  3. Eleftherios Archavlis
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  4. Iosif Strouthos
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  5. Eleni Zoga
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  7. Basil Hilaris
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  8. Dimos Baltas
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Corresponding author

Correspondence to Georgios Chatzikonstantinou.

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Conflict of interest

G. Chatzikonstantinou, N. Zamboglou, E. Archavlis, I. Strouthos, E. Zoga, N. Milickovic, B. Hilaris, D. Baltas, C. Rödel and N. Tselis declare that they have no competing interests.

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Chatzikonstantinou, G., Zamboglou, N., Archavlis, E. et al. CT-guided interstitial HDR-brachytherapy for recurrent glioblastoma multiforme: a 20-year single-institute experience. Strahlenther Onkol 194, 1171–1179 (2018). https://doi.org/10.1007/s00066-018-1358-3

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