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

Objective: Toxicity and safety study of concurrent cisplatin therapy a nd iodine 125 (I-125) brachytherapy. Background: Iodine 125 brachyther apy has an established role in surgically accessible recurrent tumors of brain. Cisplatin has antitumoral activity against glial neoplasms a nd has demonstrated sensitization of tumor to radiotherapy. Design/Met hods: In 16 patients (age range, 13 to 68 years; median, 47 years), st ereotactically 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). His tologic 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)). R esults: Early complications included headache (n=7), transient exacerb ations of preexisting neurologic deficits (n=5), seizures (n=3), and n ausea/vomiting (n=3). Late complications included steroid dependency ( n=10), progressive dementia in the absence of recurrent tumor (n=1), a nd radiation-induced necrosis (n=9) requiring reoperation (n=9). Fifte en of 16 patients were assessable, with a median follow-up time of 9.5 months. Brachytherapy was discontinued in one patient owing to an acu te subdural hematoma. A partial response was seen in five patients, di sease remained stable in seven patients, and disease progressed in thr ee patients. Conclusions: We conclude that I-125 brachytherapy with co ncurrent cisplatin therapy is associated with an acceptable level of t o;dc effects and warrants further investigation.