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Immediate post-operative brachytherapy prior to irradiation and temozolomide for newly diagnosed glioblastoma

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Abstract

To determine whether immediate post-operative brachytherapy can be safely applied to newly diagnosed glioblastomas to retard tumor progression prior to initiation of external beam radiation therapy (EBRT) and temozolomide. Between 1996 and 2011, eleven patients underwent implantation of GliaSite (n = 9) or MammoSite (n = 2) at the time of surgical resection. Brachytherapy was carried out on post-operative day 2–3, with 45–60 Gy delivered to a 1 cm margin. All patients underwent subsequent standard radiation/temozolomide treatment 4–5 weeks post-irradiation. There were no wound related complications. Toxicity was observed in two patients (2/11 or 18 %), including one post-operative seizure and one case of cerebral edema that resolved after a course of steroid treatment. Immediate post-operative and pre-irradiation/temozolomide magnetic resonance imaging assessment was available for 9 of the 11 patients. Two of these nine patients (22 %) developed new regions of contrast enhancement prior to irradiation/temozolomide. This compares favorably to historical data where 53 % of patient suffer such tumor progression. While there was a trend toward improved 6 month progression free survival in the brachytherapy/temozolomide/radiation treated patients, the overall survival of these patients were comparable to historical controls. This case series demonstrates the safety of immediate post-operative brachytherapy when applied prior to EBRT and temozolomide in the treatment of newly diagnosed glioblastomas.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Neurosurgery, Center for Theoretic and Applied Neuro-Oncology, University of California, San Diego, 3855 Health Science Drive #0987, La Jolla, CA, 92093-0987, USA

    J. Dawn Waters, David D. Gonda, John F. Alksne, Bob S. Carter & Clark C. Chen

  2. Harvard Radiation Oncology, Harvard Medical School, 350 Longwood Avenue, Galleria, Suite 205, Boston, MA, 02115, USA

    Brent Rose

  3. Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dr. #0843, La Jolla, CA, 92093-0843, USA

    Daniel J. Scanderbeg, Michelle Russell, Kevin Murphy & Joshua Lawson

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  1. J. Dawn Waters
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  2. Brent Rose
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  3. David D. Gonda
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  10. Clark C. Chen
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Correspondence to Clark C. Chen.

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J. Dawn Waters and Brent Rose have contributed equally as first authors.

Joshua Lawson and Clark C. Chen have contributed equally as senior authors.

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Waters, J.D., Rose, B., Gonda, D.D. et al. Immediate post-operative brachytherapy prior to irradiation and temozolomide for newly diagnosed glioblastoma. J Neurooncol 113, 467–477 (2013). https://doi.org/10.1007/s11060-013-1139-x

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  • DOI: https://doi.org/10.1007/s11060-013-1139-x

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