High-dose-rate stereotactic brachytherapy for patients with newly diagnosed glioblastoma multiformes

Purpose: To evaluate high-dose (HDR) stereotactic brachytherapy (STBT) for glioblastoma multiforme (GBM). Materials and methods: Between August 1994 and December 1998, 28 patients with newly diagnosed GBM underwent surgery, external-beam radiotherapy (EBRT) and HDR STBT. STBT eligibility criteria included unifocal lesions, residual tumor ≤6 cm in maximum diameter, supratentorial lesions, tumors not crossing the midline, tumors without subependymal spread and Karnofsky performance status (KPS) >60. STBT was delivered over five consecutive days with two fractions per day for a total median dose of 30 Gy. Twenty-eight STBT eligible GBM patients treated with surgery and EBRT only over the same period were matched controls. Results: Median survival times for STBT group and controls were 19.5 versus 12.5 months; one and two year survival rates were 89% versus 42% and 61% versus 28%, respectively (p = 0.12). Using multivariate analysis, age, KPS and HDR STBT were significant factors predicting survival. By RPA class, 2-year survival rates for STBT and controls were: III - 78% versus 50%; IV - 40% versus 0%; V - 21% versus 15%, respectively. Corresponding median survival times in months were: 41.6 versus 21.2 (p = 0.39); 16.7 versus 12.1 (p = 0.36); 18.7 versus 10.6 (p = 0.02). No major complications were found in the STBT arm. Conclusions: Because of small patient numbers, median survival time increases were only statistically significant in the RPA Class V patients, but a strong survival time trend emerged favoring patients undergoing HDR STBT. Further prospective study is warranted to fully assess the merits of this technique for GBM management.