New perspectives in brachycurietherapy of malignant brain tumors. Preliminary report

Between 1980 and 1988, 16 patients (9 females, 7 males) with malignant neuroepithelial tumors of the brain were treated by brachycurietherapy (BCT) and external radiation therapy (ERT) in a phase II nonrandomized study. There were 13 grade III and 3 grade IV tumors according to the WHO classification. Five patients in the grade III group who showed anaplastic foci in a generally grade II background were separately examined. Six patients received only BCT whereas 10 patients were treated by a combination of BCT and ERT, according to the tumor volume. We utilized as radioactive sources 192Ir in 14 cases and 125I in 2. Thirteen patients underwent permanent implant, 3 others received temporary irradiation with removable afterloaded catheters. The target volume was less than 50 cc in 8 cases, between 50 and 100 cc in 7, and larger than 100 cc in 1 patient. The total dose at the periphery of these volume ranged between 70 and 144 Gy. The result were analyzed referring to the following aspects: performance status, survival, side effects, grading. The impact of BCT was analyzed especially in a grade III with anaplastic foci group which showed a median survival of 6 years compared with only 2 years median survival of the pure grade III group.