Clinical original contribution
Patterns of recurrence of glioblastoma multiforme after external irradiation followed by implant boost

https://doi.org/10.1016/0360-3016(94)90559-2Get rights and content

Abstract

Purpose: To study patterns of recurrence in patients with focal primary glioblastoma treated on Northern California Oncology Group protocol 6G-82-2 including surgery, focal external beam radiotherapy (59.4–60 Gy) with oral hydroxyurea followed by temporary brain implant with high-activity iodine-125 sources (50 Gy), and six cycles of chemotherapy with procarbazine, lomustine, and vincristine.

Methods and Materials: Serial brain imaging scans were available for review in 25 of 34 patients with glioblastoma who underwent brain implant boost. Of 381 scans performed between the date of diagnosis and the date of death or last follow-up, 362 (95%) were re-reviewed. Disease progression was scored as local (within 2 cm of the implant site), separate within the brain parenchyma (⩾ 2 cm from the implant site), subependymal, or systemic. Both initial and subsequent failures were scored.

Results: Three patients are 5-year survivors, without evidence of disease, at 267, 292, and 308 weeks. Of the 22 initial sites of failure, 17 (77%) were local, three (14%) were separate brain lesions (one of which was due in retrospect to multicentric disease at diagnosis), one (5%) subependymal, and one (5%) systemic. Five patients with local failure later had other sites of failure, including a separate brain lesion in 1, subependymal spread in 3, and both in 1. One patient with separate brain failure later had local progression and then subependymal spread.

Conclusion: Although there was a significant risk of separate brain lesions or subependymal spread over time, local tumor progression was the predominant pattern of failure.

References (24)

  • R. Bashir et al.

    Regrowth patterns of glioblastoma multiforme related to planning of interstitial brachytherapy radiation fields

    Neurosurgery

    (1988)
  • P.C. Burger

    Pathologic anatomy and CT correlations in the glioblastoma multiforme

    Appl. Neurophysiol.

    (1983)
  • Cited by (171)

    • Nanomedicine: future therapy for brain cancers

      2020, Nano Drug Delivery Strategies for the Treatment of Cancers
    • Gamma Knife Stereotactic Radiosurgery in Combination with Bevacizumab for Recurrent Glioblastoma

      2019, World Neurosurgery
      Citation Excerpt :

      It is associated with a median overall survival (OS) of <2 years.1,2 The majority of recurrences occur within 2-cm margins of the resection cavity and management is limited by treatment morbidity, particularly when recurrent disease is diffuse.3 Salvage therapy options include reoperation, chemotherapy, fractionated reirradiation, stereotactic radiosurgery (SRS), and various targeted therapies, which have shown mixed success.2,4-6

    • Late Effects of Radiation Prime the Brain Microenvironment for Accelerated Tumor Growth

      2019, International Journal of Radiation Oncology Biology Physics
    View all citing articles on Scopus

    Presented at the 35th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, New Orleans, LA, 11–15 October 1993.

    View full text