Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-23T20:33:48.587Z Has data issue: false hasContentIssue false

Coincidence vs Cause: Cure in Three Glioblastoma Patients Treated with Brachytherapy

Published online by Cambridge University Press:  02 December 2014

Amir R. Dehdashti
Affiliation:
The Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
Sunjay Sharma
Affiliation:
The Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
Normand Laperriere
Affiliation:
The Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
Mark Bernstein
Affiliation:
The Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Very long term survival after diagnosis of malignant glioma has been described in individual case reports. Survival of more than 10 years is extremely rare, especially when identified in 3 out of 71 patients assigned to one arm of a randomized controlled trial.

Patients:

Three patients survived 11, 16, and 18 years following the diagnosis of glioblastoma and treatment with surgery, conventional fractionated radiation, and high-activity iodine-125 boost brachytherapy as part of a randomized controlled trial.

Conclusion:

Despite this apparent cause and effect relationship, statistical analysis shows no relationship between these cures and treatment with brachytherapy. Cure of glioblastoma remains rare.

Résumé:

RÉSUMÉ:

Coïidence vs cause : guérison chez trois patients atteints de glioblastome traités par brachythérapie.

Contexte:

Quelques patients ayant eu une survie très longue après un diagnostic de gliome malin ont été décrits antérieurement. Une survie de plus de 10 ans est extrêmement rare, d'autant plus qu'on l'a observée chez trois patients d'un groupe de 71 patients assignés au même bras d'une étude contrôlée randomisée. Observations : Trois patients ont survécu 11, 16 et 18 ans respectivement après le diagnostic de glioblastome et leur participation à une étude contrôlée randomisée comparant le traitement par chirurgie, radiothérapie fractionnée conventionnelle et brachythérapie par l'iode-125 comme source de radioactivité de haute activité. Conclusion : Malgré qu'il semble exister ici une relation de cause à effet, l'analyse statistique n'a pas montré de relation entre ces cas de guérison et le traitement par brachythérapie. Les cas de guérison du glioblastome demeurent rares.

Type
Original Articles
Copyright
Copyright © The Canadian Journal of Neurological 2007

References

1. Mirimanoff, RO, Gorlia, T, Mason, W, Van den Bent, MJ, Kortmann, RD, Fisher, B, et al. Radiotherapy and temozolomide for newly diagnosed glioblastoma: recursive partitioning analysis of the EORTC 26981/22981-NCIC CE3 phase III randomized trial. J Clin Oncol. 2006;24:25639.Google Scholar
2. Wallner, KE, Galicich, JH, Krol, G, Arbit, E, Malkin, MG. Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Rad Onc Biol Phys. 1989;16:14059.CrossRefGoogle ScholarPubMed
3. Walker, MD, Green, SB, Byar, DP, Alexander, E, Batzdorf, U, Brooks, WH, et al. Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med. 1980;303:13239.CrossRefGoogle ScholarPubMed
4. Stupp, R, Mason, WP, van den Bent, MJ, Weller, M, Fisher, B, Taphoorn, MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:98796.Google Scholar
5. Hegi, ME, Diserens, AC, Gorlia, T, Hamou, MF, de Tribolet, N, Weller, M, et al. MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med. 2005;352:9971003.Google Scholar
6. Bashir, R, Hochberg, F, Oot, R. Regrowth patterns of glioblastoma multiforme related to planning of interstitial brachytherapy radiation fields. Neurosurgery. 1988;23:2730.CrossRefGoogle ScholarPubMed
7. Sneed, PK, Gutin, PH, Larson, DA, Malec, MK, Phillips, TL, Prados, MD, et al. Patterns of recurrence of glioblastoma multiforme after external irradiation followed by implant boost. Int J Rad Onc Biol Phys. 1994;29:71927.Google Scholar
8. Albert, FK, Forsting, M, Sartor, K, Adams, HP, Kunze, S. Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery. 1994;34:4560.Google Scholar
9. Scott, JN, Rewcastle, NB, Brasher, PM, Fulton, D, MacKinnon, JA, Hamilton, M, et al. Which glioblastoma multiforme patient will become a long-term survivor? A population-based study. Ann Neurol. 1999;46:1838.3.0.CO;2-7>CrossRefGoogle ScholarPubMed
10. Hitchon, PW, VanGilder, JC, Wen, BC, Jani, S. Brachytherapy for malignant recurrent and untreated gliomas. Stereotact Funct Neurosurg. 1992;59:1748.Google Scholar
11. Leibel, SA, Gutin, PH, Wara, WM, Silver, PS, Larson, DA, Edwards, MS, et al. Survival and quality of life after interstitial implantation of removable high-activity iodine-125 sources for the treatment of patients with recurrent malignant gliomas. Int J Rad Onc Biol Phys. 1989;17:112939.CrossRefGoogle ScholarPubMed
12. Patel, S, Breneman, JC, Warnick, RE, Albright, RE, Tobler, WD, van Loveren, HR, et al. Permanent iodine-125 interstitial implants for the treatment of recurrent glioblastoma multiforme. Neurosurgery. 2000;46:11238.Google Scholar
13. Prados, MD, Gutin, PH, Phillips, TL, Wara, WM, Sneed, PK, Larson, DA, et al. Interstitial brachytherapy for newly diagnosed patients with malignant gliomas: the UCSF experience. Int J Rad Onc Biol Phys. 1992;24:5937.Google Scholar
14. Mayr, MT, Crocker, IR, Butker, EK, Williams, H, Cotsonis, GA, Olson, JJ. Results of interstitial brachytherapy for malignant brain tumors. Int J Oncol. 2002;21:81723.Google ScholarPubMed
15. Laperriere, NJ, Leung, PM, McKenzie, S, Milosevic, M, Wong, S, Glen, J, et al. Randomized study of brachytherapy in the initial management of patients with malignant astrocytoma. Int J Rad Onc Biol Phys. 1998;41:100511.CrossRefGoogle ScholarPubMed
16. Selker, RG, Shapiro, WR, Burger, P, Blackwood, MS, Arena, VC, Gilder, JC, et al. The Brain Tumor Cooperative Group NIH Trial 87-01: a randomized comparison of surgery, external radiotherapy, and carmustine versus surgery, interstitial radiotherapy boost, external radiation therapy, and carmustine. Neurosurgery. 2002;51:34355.Google Scholar
17. Chang, CH, Horton, J, Schoenfeld, D, Salazer, O, Perez-Tamayo, R, Kramer, S, et al. Comparison of postoperative radiotherapy and combined postoperative radiotherapy and chemotherapy in the multidisciplinary management of malignant gliomas. A joint Radiation Therapy Oncology Group and Eastern Cooperative Oncology Group study. Cancer. 1983;52:9971007.Google Scholar
18. Bernstein, M, Laperriere, N, Glen, J, Leung, P, Thomason, C, Landon, AE. Brachytherapy for recurrent malignant astrocytoma. Int J Rad Onc Biol Phys. 1994;30:121317.Google Scholar
19. Ling, CC, Anderson, LL, Shipley, WU. Dose inhomogeneity in interstitial implants using 125I seeds. Int J Rad Onc Biol Phys. 1979;5:41925.CrossRefGoogle Scholar
20. Reardon, DA, Akabani, G, Coleman, RE, Friedman, AH, Friedman, HS, Herndon, JE, et al. Phase II trial of murine (131) I-labeled antitenascin monoclonal antibody 81C6 administered into surgically created resection cavities of patients with newly diagnosed malignant gliomas. J Clin Oncol. 2002;20:138997.CrossRefGoogle ScholarPubMed
21. Bampoe, J, Laperriere, N, Pintilie, M, Glen, J, Micallef, J, Bernstein, M. Quality of life in patients with glioblastoma multiforme participating in a randomized study of brachytherapy as a boost treatment. J Neurosurg. 2000;93:91726.Google Scholar
22. Wen, PY, Alexander, E, Black, PM, Fine, HA, Riese, N, Levin, JM, et al. Long term results of stereotactic brachytherapy used in the initial treatment of patients with glioblastomas. Cancer. 1994;73:302936.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
23. Gabayan, AJ, Green, SB, Sanan, A, Jenrette, J, Schultz, C, Papagikos, M, et al. GliaSite brachytherapy for treatment of recurrent malignant gliomas: a retrospective multi-institutional analysis. Neurosurgery. 2006;58:7019.Google Scholar
24. Ammirati, M, Vick, N, Liao, YL, Ciric, I, Mikhael, M. Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurgery. 1987;21:2016.CrossRefGoogle ScholarPubMed
25. Lacroix, M, Abi-Said, D, Fourney, DR, Gokaslan, ZL, Shi, W, DeMonte, F, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 2001;95:1908.Google Scholar
26. Kraus, JA, Wenghoefer, M, Schmidt, MC, von Deimling, A, Berweiler, U, Roggendorf, W, et al. Long-term survival of glioblastoma multiforme: importance of histopathological reevaluation. J Neurol. 2000;247:45560.Google Scholar
27. Dehdashti, AR, Hegi, ME, Regli, L, Pica, A, Stupp, R. New trends in the medical management of glioblastoma multiforme: the role of temozolomide chemotherapy. Neurosurg Focus. 2006;20:E6.Google Scholar
28. Bucy, PC, Oberhill, HR, Siqueira, EB, Zimmerman, HM, Jelsma, RK. Cerebral glioblastoma can be cured. Neurosurgery. 1985;16:71417.Google Scholar
29. Burzynski, SR, Lewy, RI, Weaver, R, Janicki, T, Jurida, G, Khan, M, et al. Long-term survival and complete response of a patient with recurrent diffuse intrinsic brain stem glioblastoma multiforme. Integr Cancer Ther. 2004;3:25761.CrossRefGoogle ScholarPubMed
30. Yoshida, T, Kawano, N, Oka, H, Fujii, K, Makazato, Y. Clinical cure of glioblastoma - two case reports. Neurol Med Chir (Tokyo). 2000;40:2249.Google Scholar
31. Price, SJ, Jena, R, Burnet, NG, Hutchinson, PJ, Dean, AF, Pena, A, et al. Improved delineation of glioma margins and regions of infiltration with the use of diffusion tensor imaging: an imageguided biopsy study. AJNR. 2006;27:196974.Google Scholar