caa a22 4500 606215220 CHVBK 20210128101057.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s00701-015-2550-1 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2550-1 Outcome and toxicity profile of salvage low-dose-rate iodine-125 stereotactic brachytherapy in recurrent high-grade gliomas [Elektronische Daten] [Christoph Schwartz, Alexander Romagna, Niklas Thon, Maximilian Niyazi, Juliana Watson, Claus Belka, Jörg-Christian Tonn, Friedrich-Wilhelm Kreth, Silke Nachbichler] Background: The aim of this study was to provide an outcome and toxicity profile of salvage low-dose-rate iodine-125 (I-125) stereotactic brachytherapy (SBT) in patients with small, circumscribed malignant glioma recurrences. Methods: Patients with malignant glioma recurrences consecutively undergoing salvage SBT from 2003 to 2011 were identified from our prospective tumor database. SBT was considered a potentially suitable treatment strategy for adult mostly multimodally pretreated patients (Karnofsky score of ≥ 70) with biopsy-proven, circumscribed, small (diameter ≤ 3.5cm) recurrences. Exclusively temporary I-125 seeds were used (reference dose: 50Gy, dose rate: < 15cGy/h). Study endpoints were time-to-treatment failure (TTF) after SBT, postrecurrence survival (PRS), and toxicity. Survival was assessed with the Kaplan-Meier method. Adverse events were categorized according to the RTOG/EORTC classification. Prognostic factors were obtained from proportional hazards models. Results: Sixty-eight patients (28 WHO grade III, 40 WHO grade IV gliomas) were included. Fifty-nine patients had previously received external beam radiation. Median TTF and PRS were 8.3months and 13.4months, respectively. TTF and PRS were longer for grade III gliomas than for glioblastomas (15.0 vs. 6.2months and 28.1 vs. 9.3months, respectively). Patients with grade III tumors were younger (p = 0.002). Favorable factors for TTF and PRS were age ≤ 50years and a methylated O(6)-methylguanine-DNA methyltransferase (MGMT)-promoter. Alternative models including tumor grade instead of age reached a similar good fit. Three patients suffered from grade I, one from grade II, and two from grade IV toxicity. Conclusions: Salvage SBT is feasible and safe even after previously performed external beam radiation. Favorable outcome measurements in particular for grade III recurrences deserve further prospective evaluation. Springer-Verlag Wien, 2015 High-grade glioma nationallicence Brachytherapy nationallicence Postrecurrence survival nationallicence Schwartz Christoph Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany aut Romagna Alexander Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany aut Thon Niklas Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany aut Niyazi Maximilian Department of Radiation-Oncology, Ludwig-Maximilians-University, Munich, Germany aut Watson Juliana Department of Radiation-Oncology, Ludwig-Maximilians-University, Munich, Germany aut Belka Claus Department of Radiation-Oncology, Ludwig-Maximilians-University, Munich, Germany aut Tonn Jörg-Christian Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany aut Kreth Friedrich-Wilhelm Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany aut Nachbichler Silke Department of Radiation-Oncology, Ludwig-Maximilians-University, Munich, Germany aut Acta Neurochirurgica Springer Vienna 157/10(2015-10-01), 1757-1764 0001-6268 157:10<1757 2015 157 701 https://doi.org/10.1007/s00701-015-2550-1 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2550-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Schwartz Christoph Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany aut NATIONALLICENCE 700 1- Romagna Alexander Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany aut NATIONALLICENCE 700 1- Thon Niklas Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany aut NATIONALLICENCE 700 1- Niyazi Maximilian Department of Radiation-Oncology, Ludwig-Maximilians-University, Munich, Germany aut NATIONALLICENCE 700 1- Watson Juliana Department of Radiation-Oncology, Ludwig-Maximilians-University, Munich, Germany aut NATIONALLICENCE 700 1- Belka Claus Department of Radiation-Oncology, Ludwig-Maximilians-University, Munich, Germany aut NATIONALLICENCE 700 1- Tonn Jörg-Christian Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany aut NATIONALLICENCE 700 1- Kreth Friedrich-Wilhelm Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany aut NATIONALLICENCE 700 1- Nachbichler Silke Department of Radiation-Oncology, Ludwig-Maximilians-University, Munich, Germany aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/10(2015-10-01), 1757-1764 0001-6268 157:10<1757 2015 157 701