CONCURRENT CISPLATIN THERAPY AND IODINE-125 BRACHYTHERAPY FOR RECURRENT MALIGNANT BRAIN-TUMORS

Objective: Toxicity and safety study of concurrent cisplatin therapy and iodine 125 (I-125) brachytherapy. Background: Iodine 125 brachytherapy has an established role in surgically accessible recurrent tumors of brain. Cisplatin has antitumoral activity against glial neoplasms and has demonstrated sensitization of tumor to radiotherapy. Design/Methods: In 16 patients (age range, 13 to 68 years; median, 47 years), stereotactically placed catheters were afterloaded with I-125 sources. A median 50-Gy minimum treatment volume dose was delivered during a 100-hour period along with cisplatin (20 mg/m(2) per day for 5 days). Histologic diagnoses included glioblastoma multiforme (n=11), anaplastic astrocytoma (n=3), ependymoma (n=1), and anaplastic oligodendroglioma (n=1). Tumor volumes ranged from 7.0 to 73 cm(3) (median, 25 cm(3)). Results: Early complications included headache (n=7), transient exacerbations of preexisting neurologic deficits (n=5), seizures (n=3), and nausea/vomiting (n=3). Late complications included steroid dependency (n=10), progressive dementia in the absence of recurrent tumor (n=1), and radiation-induced necrosis (n=9) requiring reoperation (n=9). Fifteen of 16 patients were assessable, with a median follow-up time of 9.5 months. Brachytherapy was discontinued in one patient owing to an acute subdural hematoma. A partial response was seen in five patients, disease remained stable in seven patients, and disease progressed in three patients. Conclusions: We conclude that I-125 brachytherapy with concurrent cisplatin therapy is associated with an acceptable level of to;dc effects and warrants further investigation.