Intraoperative radiation therapy for glioblastoma and brain metastases: Program development and initial experience
Kathleen Joy O Khu1, Juan Silvestre G Pascual1, Johanna Patricia A Cañal2
1Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines.
Background:
Intraoperative radiation therapy (IORT) is a technique that precisely delivers ionizing radiation to the tumor or tumor bed during surgery. It is currently used for glioblastoma (GBM) and brain metastases (BrM). We report our experience in establishing our Neuro IORT program and preliminary results, which represent the first brain IORT procedures performed in the country.
Methods:
Adult patients with a single, superficial, supratentorial brain tumor and a pre-operative diagnosis of GBM or BrM were considered for IORT. The recommendation for IORT was made after discussion in a multidisciplinary conference. Intraoperative tumor specimens were submitted for frozen section, and IORT commenced once the diagnosis was confirmed. Demographic and clinical patient data, imaging findings, IORT treatment parameters, and short-term outcomes were recorded.
Results:
Twelve patients underwent IORT: 9 BrM and 3 GBM. The mean age was 56.9 years (range 45-70), and majority were women. Most of the BrM patients had breast cancer, followed by lung, thyroid, and renal cell cancer. The mean maximum tumor diameter was 3.7 cm for BrM and 4.1 cm for GBM. The IORT dose ranged from 20-21 Gy to the surface of the resection cavity, and mean IORT duration was 13.3 min (range 6-20) for BrM and 18 min (range 14-21) for GBM. The most common morbidity was focal neurologic deficits, seen in 33 % of patients.
Conclusion:
IORT for BrM and GBM is safe and feasible in resource-limited settings. More work needs to be done to overcome the challenges and improve the program.
