Clinical Analysis of Brachytherapy Using Iodine-125 and Iridium-192 for the Treatment of Intracranial Malignant Gliomas

Cho, Kyung Gi; Chung, Sang Sup; Kim, Young Su; Choi, Joong Uhn; Lee, Kyu Chang; Kim, Su Kon; Suh, Chang Ok

Abstract

Twenty-nine patients haboring primary or recurrent malignant gliomas were treated with direct implantation of radioactive sources into the tumor in afterlozded, removable catheters using stereotatic technique between November 1987 and October 1990. Indine-125(I-125) was implanted in 22 patients and high dose rate(HDR) Iridium-192(Ir-192) in 7 patients. All patients had been treated with external radiation and most had been treated with chemotherapeutic agents. one or more sources were placed in each tumor to deliver 5000-8000 cGy to the tumor's periphery for I-125 and 3000 cGy for HDR Ir-192. Eleven of 13 patients with glioblastoma multiforme were alive at 35 weeks whose mean survival was 74 weeks, and remained two were expired at 35 and 78 weeks, respectively. All 5 patients with anaplastic astrocytoma were alive at 39 weeks whose mean survival was 74 weeks. Five of 9 recurrent blioblastoma were alive at 22 weeks whose mean survival was 44 weeks, and remained three were expired at 13, 17 and 22 weeks respectively. All two patients with anaplastic astrocytoma were alive at 22 and 52 weeks, respectively. Four patients with deep seated analphastic astrocytoma(3 in the thalamus and 1 in the third ventricle) were treated successfully by brachytheray without any surgical morbidity and mortality and they were still alive 38, 48, 74 and 123 weeks after brachytherapy. There were few minor postoperative complications including 3 meningitis. 2 leak of cerebrospinal fluid and 3 radiation necrosis without any mortality. The authors conclude that the brachytherapy with temporary implanted I-125 or Ir-192 sources may provide long-term survial in selected patients with primary or recurrent malignant gliomas.