Long-Term Follow-Up of Brachytherapy in Untreated Malignant Glioma

Objective: Long-term follow-up of patients with malignant glioma randomized to treatment with and without brachytherapy. Methods: Twenty-six patients were randomized to brachytherapy and external radiation, and 23 to external radiation alone. There were 19 and 17 glioblastomas, and 3 and 8 anaplastic astrocytomas, in the nonimplant and implant groups, respectively, and 1 malignant oligodendroglioma in each group. For brachytherapy, iodine- 125 seeds were implanted to deliver a homogeneous dose of 40 cGy/hr for a maximum of 6000 cGy to the enhancing tumor margin. All patients received external radiation for a total of 6020 cGy delivered to the tumor plus 3 cm margin over 7 weeks, followed by BCNU chemotherapy. Conclusions: The median survival was 78 and 66 weeks in the implant and nonimplant groups respectively, and their survival curves were not different (log rank, p=0.394). A significant multivariate relationship did exist between survival and age (p=0.0092), tumor grade (p=0.0001), and Karnofsky (p=0.021). Treatment with brachytherapy is subject to selection bias, which does exclude a large proportion of patients.