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Controversies concerning the application of brachytherapy in central nervous system tumors



Brachytherapy (BRT) is defined as a therapy technique where a radioactive source is placed a short distance from or within the tumor being treated. Much expectation has been placed on its efficacy to improve the outcome for patients with central nervous system (CNS) tumors due to the initial promising results from single institution retrospective studies. However, these optimistic findings have been highly debated since the selection criteria itself is preferable to other therapeutic modalities. The fact that BRT demonstrated no significant survival advantage in two prospective studies, together with the emerging role of stereotactic convergence therapy as a promising alternative, has further decreased the enthusiasm for BRT. Despite all the negative aspects, BRT continues to be conducted for the management of CNS tumors including gliomas, meningiomas and brain metastases.

Material and methods

As many controversies have been aroused concerning the experience and future application of BRT, this article reviews the existing heterogeneities in terms of implants choice, optimal dose rate, targeting volume, timing of BRT, patients selection, substantial efficacy, BRT in comparison with stereotactic convergence therapy techniques and BRT in combination with other treatment modalities (data were identified by Pubmed searches).

Results and conclusion

Though it is inconvincible to argue for the routine use of BRT, BRT may provide a choice for patients with large recurrent or inoperable deep-seated tumors, especially with the Glia-site technique. Radiotherapies including BRT may hold more promise if biologic mechanisms of radiation could be better understand and biologic modifications could be added in clinical trials.

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  1. Bampoe J, Laperriere N, Pintilie M, Glen J, Micallef J, Bernstein M (2000) Quality of life in patients with glioblastoma multiforme participating in a randomized study of brachytherapy as a boost treatment. J Neurosurg 93:917–926

  2. Beach JL, Schroy CB, Ashtari M, Harris MR, Maruyama Y (1990) Boron neutron capture enhancement of 252Cf brachytherapy. Int J Radiat Oncol Biol Phys 18:1421–1427

  3. Bernstein M, Laperriere N (1995) Indications for brachytherapy for brain tumours. Acta Neurochir Suppl 63:25–28

  4. Bernstein M, Laperriere N, Glen J, Leung P, Thomason C, Landon AE (1994) Brachytherapy for recurrent malignant astrocytoma. Int J Radiat Oncol Biol Phys 30:1213–1217

  5. Black PM (1991) Brain tumors. Part 1. N Engl J Med 324:1471–1476

  6. Bogart JA, Ungureanu C, Shihadeh E, Chung TC, King GA, Ryu S, Kent C, Winfield JA (1999) Resection and permanent I-125 brachytherapy without whole brain irradiation for solitary brain metastasis from non-small cell lung carcinoma. J Neurooncol 44:53–57

  7. Burger PC, Mahley MS Jr, Dudka L, Vogel FS (1979) The morphologic effects of radiation administered therapeutically for intracranial gliomas: a postmortem study of 25 cases. Cancer 44:1256–1272

  8. Burnet NG, Jena R, Jefferies SJ, Stenning SP, Kirkby NF (2006) Mathematical modelling of survival of glioblastoma patients suggests a role for radiotherapy dose escalation and predicts poorer outcome after delay to start treatment. Clin Oncol (R Coll Radiol) 18:93–103

  9. Chamberlain MC, Barba D, Kormanik P, Berson AM, Saunders WM, Shea MC (1995) Concurrent cisplatin therapy and iodine 125 brachytherapy for recurrent malignant brain tumors. Arch Neurol 52:162–167

  10. Chan TA, Weingart JD, Parisi M, Hughes MA, Olivi A, Borzillary S, Alahakone D, Detorie NA, Wharam MD, Kleinberg L (2005) Treatment of recurrent glioblastoma multiforme with GliaSite brachytherapy. Int J Radiat Oncol Biol Phys 62:1133–1139

  11. Cheng JX, Zhang X, Liu BL (2009) Health-related quality of life in patients with high-grade glioma. Neuro Oncol 11:41–50

  12. Combs SE, Thilmann C, Edler L, Debus J, Schulz-Ertner D (2005) Efficacy of fractionated stereotactic reirradiation in recurrent gliomas: long-term results in 172 patients treated in a single institution. J Clin Oncol 23:8863–8869

  13. Combs SE, Debus J, Schulz-Ertner D (2007) Radiotherapeutic alternatives for previously irradiated recurrent gliomas. BMC Cancer 7:167

  14. Curran WJ Jr, Scott CB, Horton J, Nelson JS, Weinstein AS, Fischbach AJ, Chang CH, Rotman M, Asbell SO, Krisch RE et al (1993) Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst 85:704–710

  15. Dagnew E, Kanski J, McDermott MW, Sneed PK, McPherson C, Breneman JC, Warnick RE (2007) Management of newly diagnosed single brain metastasis using resection and permanent iodine-125 seeds without initial whole-brain radiotherapy: a two institution experience. Neurosurg Focus 22:E3

  16. Dunbar SF, Tarbell NJ, Kooy HM, Alexander E III, Black PM, Barnes PD, Goumnerova L, Scott RM, Pomeroy SL, La Vally B et al (1994) Stereotactic radiotherapy for pediatric and adult brain tumors: preliminary report. Int J Radiat Oncol Biol Phys 30:531–539

  17. Fernandez PM, Zamorano L, Yakar D, Gaspar L, Warmelink C (1995) Permanent iodine-125 implants in the up-front treatment of malignant gliomas. Neurosurgery 36:467–473

  18. Florell RC, Macdonald DR, Irish WD, Bernstein M, Leibel SA, Gutin PH, Cairncross JG (1992) Selection bias, survival, and brachytherapy for glioma. J Neurosurg 76:179–183

  19. Freeman CR, Souhami L, Caron JL, Villemure JG, Olivier A, Montes J, Farmer JP, Podgorsak EB (1994) Stereotactic external beam irradiation in previously untreated brain tumors in children and adolescents. Med Pediatr Oncol 22:173–180

  20. Gabayan AJ, Green SB, Sanan A, Jenrette J, Schultz C, Papagikos M, Tatter SP, Patel A, Amin P, Lustig R, Bastin KT, Watson G, Burri S, Stea B (2006) GliaSite brachytherapy for treatment of recurrent malignant gliomas: a retrospective multi-institutional analysis. Neurosurgery 58:701–709 discussion 701–709

  21. Gerweck LE, Richards B (1981) Influence of pH on the thermal sensitivity of cultured human glioblastoma cells. Cancer Res 41:845–849

  22. Grabb PA, Lunsford LD, Albright AL, Kondziolka D, Flickinger JC (1996) Stereotactic radiosurgery for glial neoplasms of childhood. Neurosurgery 38:696–701 discussion 701–702

  23. Grabenbauer GG, Roedel CM, Paulus W, Ganslandt O, Schuchardt U, Buchfelder M, Schrell U, Fahlbusch R, Huk WJ, Sauer R (2000) Supratentorial low-grade glioma: results and prognostic factors following postoperative radiotherapy. Strahlenther Onkol 176:259–264

  24. Graves EE, Nelson SJ, Vigneron DB, Chin C, Verhey L, McDermott M, Larson D, Sneed PK, Chang S, Prados MD, Lamborn K, Dillon WP (2000) A preliminary study of the prognostic value of proton magnetic resonance spectroscopic imaging in gamma knife radiosurgery of recurrent malignant gliomas. Neurosurgery 46:319–326 discussion 326–328

  25. Gregg EC, Yau TM, Kim SC (1979) Effect of Low dose rate irradiation on cell kinetics. Biophys J 28:81–92

  26. Gutin PH, Phillips TL, Wara WM, Leibel SA, Hosobuchi Y, Levin VA, Weaver KA, Lamb S (1984) Brachytherapy of recurrent malignant brain tumors with removable high-activity iodine-125 sources. J Neurosurg 60:61–68

  27. Gutin PH, Leibel SA, Hosobuchi Y, Crumley RL, Edwards MS, Wilson CB, Lamb S, Weaver KA (1987a) Brachytherapy of recurrent tumors of the skull base and spine with iodine-125 sources. Neurosurgery 20:938–945

  28. Gutin PH, Leibel SA, Wara WM, Choucair A, Levin VA, Philips TL, Silver P, Da Silva V, Edwards MS, Davis RL et al (1987b) Recurrent malignant gliomas: survival following interstitial brachytherapy with high-activity iodine-125 sources. J Neurosurg 67:864–873

  29. Gutin PH, Prados MD, Phillips TL, Wara WM, Larson DA, Leibel SA, Sneed PK, Levin VA, Weaver KA, Silver P et al (1991) External irradiation followed by an interstitial high activity iodine-125 implant “boost” in the initial treatment of malignant gliomas: NCOG study 6G-82-2. Int J Radiat Oncol Biol Phys 21:601–606

  30. Hall EJ (1988) Repair of radiation damage and the dose-rate effect. In: Hall EJ (ed) Radiobiology for the radiologist. JB Lippincott, Philadelphia, pp 107–131

  31. Halligan JB, Stelzer KJ, Rostomily RC, Spence AM, Griffin TW, Berger MS (1996) Operation and permanent low activity 125I brachytheraphy for recurrent high-grade astrocytomas. Int J Radiat Oncol Biol Phys 35:541–547

  32. Harisladis L, Sung DI, Kessaris N, Hall EJ (1978) Hyperthermia and low dose-rate irradiation. Radiology 129:195–198

  33. Hug EB, Muenter MW, Archambeau JO, DeVries A, Liwnicz B, Loredo LN, Grove RI, Slater JD (2002) Conformal proton radiation therapy for pediatric low-grade astrocytomas. Strahlenther Onkol 178:10–17

  34. Hughes SW, Sofat A, Kitchen ND, Brown A, Beaney RP, Timothy AR, Saunders JE, Thomas DG (1995) Computer planning of stereotactic iodine-125 seed brachytherapy for recurrent malignant gliomas. Br J Radiol 68:175–181

  35. Jaaskelainen J, Mantyla M (1995) Stereotactic radiotherapy of central nervous system tumors. Duodecim 111:2028–2037

  36. Janss AJ, Grundy R, Cnaan A, Savino PJ, Packer RJ, Zackai EH, Goldwein JW, Sutton LN, Radcliffe J, Molloy PT et al (1995) Optic pathway and hypothalamic/chiasmatic gliomas in children younger than age 5 years with a 6-year follow-up. Cancer 75:1051–1059

  37. Johannesen TB, Watne K, Lote K, Norum J, Hennig R, Tvera K, Hirschberg H (1999) Intracavity fractionated balloon brachytherapy in glioblastoma. Acta Neurochir (Wien) 141:127–133

  38. Julow J, Major T, Emri M, Valalik I, Sagi S, Mangel L, Nemeth G, Tron L, Varallyay G, Solymosi D, Havel J, Kiss T (2000) The application of image fusion in stereotactic brachytherapy of brain tumours. Acta Neurochir (Wien) 142:1253–1258

  39. Kassis AI, Wen PY, Van den Abbeele AD, Baranowska-Kortylewicz J, Makrigiorgos GM, Metz KR, Matalka KZ, Cook CU, Sahu SK, Black PM, Adelstein SJ (1998) 5-[125I]iodo-2′-deoxyuridine in the radiotherapy of brain tumors in rats. J Nucl Med 39:1148–1154

  40. Kolotas C, Birn G, Baltas D, Rogge B, Ulrich P, Zamboglou N (1999) CT guided interstitial high dose rate brachytherapy for recurrent malignant gliomas. Br J Radiol 72:805–808

  41. Kondziolka D, Lunsford LD, Flickinger JC (1999) The radiobiology of radiosurgery. Neurosurg Clin N Am 10:157–166

  42. Koot RW, Maarouf M, Hulshof MC, Voges J, Treuer H, Koedooder C, Sturm V, Bosch DA (2000) Brachytherapy: results of two different therapy strategies for patients with primary glioblastoma multiforme. Cancer 88:2796–2802

  43. Koot RW, de Heer K, Oort FJ, Hulshof MC, Bosch DA, de Haes JC (2004) Quality of life after brachytherapy in patients with glioblastoma multiforme. Eur J Cancer 40:1013–1020

  44. Kortmann RD, Becker G, Perelmouter J, Buchgeister M, Meisner C, Bamberg M (1999) Geometric accuracy of field alignment in fractionated stereotactic conformal radiotherapy of brain tumors. Int J Radiat Oncol Biol Phys 43:921–926

  45. Kortmann RD, Zanetti I, Mueller S, Taylor RE, Scarlello G, Perilongo G, Walker DA, Gnekow AK, Garre ML (2000) Radiotherapy in low grade glioma: an interim analysis of SIOP low grade glioma study. Proceedings of the 9th international symposium pediatric neuro-oncology, San Francisco

  46. Kortmann RD, Timmermann B, Taylor RE, Scarzello G, Plasswilm L, Paulsen F, Jeremic B, Gnekow AK, Dieckmann K, Kay S, Bamberg M (2003) Current and future strategies in radiotherapy of childhood low-grade glioma of the brain. Part I: treatment modalities of radiation therapy. Strahlenther Onkol 179:509–520

  47. Kreth FW, Faist M, Warnke PC, Rossner R, Volk B, Ostertag CB (1995) Interstitial radiosurgery of low-grade gliomas. J Neurosurg 82:418–429

  48. Kreth FW, Faist M, Rossner R, Birg W, Volk B, Ostertag CB (1997) The risk of interstitial radiotherapy of low-grade gliomas. Radiother Oncol 43:253–260

  49. Krishnaswamy V (1979) Dose tables for 125-I seed implants. Radiology 132:727–730

  50. Kumar PP, Patil AA, Leibrock LG, Chu WK, Syh J, McCaul GF, Reeves MA (1991) Brachytherapy: a viable alternative in the management of basal meningiomas. Neurosurgery 29:676–680

  51. Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, Lang FF, McCutcheon IE, Hassenbusch SJ, Holland E, Hess K, Michael C, Miller D, Sawaya R (2001) A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95:190–198

  52. Laperriere NJ, Leung PM, McKenzie S, Milosevic M, Wong S, Glen J, Pintilie M, Bernstein M (1998) Randomized study of brachytherapy in the initial management of patients with malignant astrocytoma. Int J Radiat Oncol Biol Phys 41:1005–1011

  53. Larson DA, Suplica JM, Chang SM, Lamborn KR, McDermott MW, Sneed PK, Prados MD, Wara WM, Nicholas MK, Berger MS (2004) Permanent iodine 125 brachytherapy in patients with progressive or recurrent glioblastoma multiforme. Neuro Oncol 6:119–126

  54. Ling CC, Spiro IJ, Mitchell J, Stickler R (1985) The variation of OER with dose rate. Int J Radiat Oncol Biol Phys 11:1367–1373

  55. Malkin MG (1994) Interstitial brachytherapy of malignant gliomas: the Memorial Sloan-Kettering Cancer Center experience. Recent Results Cancer Res 135:117–125

  56. McDermott MW, Berger MS, Kunwar S, Parsa AT, Sneed PK, Larson DA (2004) Stereotactic radiosurgery and interstitial brachytherapy for glial neoplasms. J Neurooncol 69:83–100

  57. Micheletti E, Baroncelli G, La Face B, Feroldi P, Galelli M, Giunta F (1994) High-dose interstitial brachytherapy for glioblastoma multiforme. Tumori 80:44–49

  58. Micheletti E, La Face B, Feroldi P, Galelli M, Buttolo L, Stefini R, Giunta F (1996) High-dose-rate brachytherapy for poor-prognosis, high-grade glioma: (phase II) preliminary results. Tumori 82:339–344

  59. Mundinger F, Braus DF, Krauss JK, Birg W (1991) Long-term outcome of 89 low-grade brain-stem gliomas after interstitial radiation therapy. J Neurosurg 75:740–746

  60. Nelson DF, Diener-West M, Horton J, Chang CH, Schoenfeld D, Nelson JS (1988) Combined modality approach to treatment of malignant gliomas—re-evaluation of RTOG 7401/ECOG 1374 with long-term follow-up: a joint study of the Radiation Therapy Oncology Group and the Eastern Cooperative Oncology Group. NCI Monogr 6:279–284

  61. Nwokedi EC, DiBiase SJ, Jabbour S, Herman J, Amin P, Chin LS (2002) Gamma knife stereotactic radiosurgery for patients with glioblastoma multiforme. Neurosurgery 50:41–46 discussion 46–47

  62. Ostertag CB, Kreth FW (1995) Interstitial iodine-125 radiosurgery for cerebral metastases. Br J Neurosurg 9:593–603

  63. Patel S, Breneman JC, Warnick RE, Albright RE Jr, Tobler WD, van Loveren HR, Tew JM Jr (2000) Permanent iodine-125 interstitial implants for the treatment of recurrent glioblastoma multiforme. Neurosurgery 46:1123–1128 discussion 1128–1130

  64. Reardon DA, Akabani G, Coleman RE, Friedman AH, Friedman HS, Herndon JE II, Cokgor I, McLendon RE, Pegram CN, Provenzale JM, Quinn JA, Rich JN, Regalado LV, Sampson JH, Shafman TD, Wikstrand CJ, Wong TZ, Zhao XG, Zalutsky MR, Bigner DD (2002) Phase II trial of murine (131)I-labeled antitenascin monoclonal antibody 81C6 administered into surgically created resection cavities of patients with newly diagnosed malignant gliomas. J Clin Oncol 20:1389–1397

  65. Rogers LR, Rock JP, Sills AK, Vogelbaum MA, Suh JH, Ellis TL, Stieber VW, Asher AL, Fraser RW, Billingsley JS, Lewis P, Schellingerhout D, Shaw EG (2006) Results of a phase II trial of the GliaSite radiation therapy system for the treatment of newly diagnosed, resected single brain metastases. J Neurosurg 105:375–384

  66. Sarkaria JN, Mehta MP, Loeffler JS, Buatti JM, Chappell RJ, Levin AB, Alexander E III, Friedman WA, Kinsella TJ (1995) Radiosurgery in the initial management of malignant gliomas: survival comparison with the RTOG recursive partitioning analysis. Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 32:931–941

  67. Scharfen CO, Sneed PK, Wara WM, Larson DA, Phillips TL, Prados MD, Weaver KA, Malec M, Acord P, Lamborn KR et al (1992) High activity iodine-125 interstitial implant for gliomas. Int J Radiat Oncol Biol Phys 24:583–591

  68. Schulz-Ertner D, Frank C, Herfarth KK, Rhein B, Wannenmacher M, Debus J (2002) Fractionated stereotactic radiotherapy for craniopharyngiomas. Int J Radiat Oncol Biol Phys 54:1114–1120

  69. Schulz-Ertner D, Nikoghosyan A, Thilmann C, Haberer T, Jakel O, Karger C, Kraft G, Wannenmacher M, Debus J (2004) Results of carbon ion radiotherapy in 152 patients. Int J Radiat Oncol Biol Phys 58:631–640

  70. Schulz-Ertner D, Nikoghosyan A, Didinger B, Munter M, Jakel O, Karger CP, Debus J (2005) Therapy strategies for locally advanced adenoid cystic carcinomas using modern radiation therapy techniques. Cancer 104:338–344

  71. Schupak K, Malkin M, Anderson L, Arbit E, Lindsley K, Leibel S (1995) The relationship between the technical accuracy of stereotactic interstitial implantation for high grade gliomas and the pattern of tumor recurrence. Int J Radiat Oncol Biol Phys 32:1167–1176

  72. Selker RG, Shapiro WR, Burger P, Blackwood MS, Arena VC, Gilder JC, Malkin MG, Mealey JJ Jr, Neal JH, Olson J, Robertson JT, Barnett GH, Bloomfield S, Albright R, Hochberg FH, Hiesiger E, Green S (2002) The Brain Tumor Cooperative Group NIH Trial 87–01: a randomized comparison of surgery, external radiotherapy, and carmustine versus surgery, interstitial radiotherapy boost, external radiation therapy, and carmustine. Neurosurgery 51:343–355 discussion 355–357

  73. Shaw EG, Daumas-Duport C, Scheithauer BW, Gilbertson DT, O’Fallon JR, Earle JD, Laws ER Jr, Okazaki H (1989) Radiation therapy in the management of low-grade supratentorial astrocytomas. J Neurosurg 70:853–861

  74. Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, Farnan N (2000) Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90–05. Int J Radiat Oncol Biol Phys 47:291–298

  75. Sheline GE, Wara WM, Smith V (1980) Therapeutic irradiation and brain injury. Int J Radiat Oncol Biol Phys 6:1215–1228

  76. Shibamoto Y, Kitakabu Y, Takahashi M, Yamashita J, Oda Y, Kikuchi H, Abe M (1993) Supratentorial low-grade astrocytoma. Correlation of computed tomography findings with effect of radiation therapy and prognostic variables. Cancer 72:190–195

  77. Shrieve DC, Alexander E III, Wen PY, Fine HA, Kooy HM, Black PM, Loeffler JS (1995) Comparison of stereotactic radiosurgery and brachytherapy in the treatment of recurrent glioblastoma multiforme. Neurosurgery 36:275–282 discussion 282–284

  78. Shrieve DC, Alexander E III, Black PM, Wen PY, Fine HA, Kooy HM, Loeffler JS (1999) Treatment of patients with primary glioblastoma multiforme with standard postoperative radiotherapy and radiosurgical boost: prognostic factors and long-term outcome. J Neurosurg 90:72–77

  79. Simpson JR, Horton J, Scott C, Curran WJ, Rubin P, Fischbach J, Isaacson S, Rotman M, Asbell SO, Nelson JS et al (1993) Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials. Int J Radiat Oncol Biol Phys 26:239–244

  80. Sneed PK, Gutin PH, Stauffer PR, Phillips TL, Prados MD, Weaver KA, Suen S, Lamb SA, Ham B, Ahn DK et al (1992) Thermoradiotherapy of recurrent malignant brain tumors. Int J Radiat Oncol Biol Phys 23:853–861

  81. Sneed PK, Gutin PH, Larson DA, Malec MK, Phillips TL, Prados MD, Scharfen CO, Weaver KA, Wara WM (1994) Patterns of recurrence of glioblastoma multiforme after external irradiation followed by implant boost. Int J Radiat Oncol Biol Phys 29:719–727

  82. Sneed PK, Stauffer PR, McDermott MW, Diederich CJ, Lamborn KR, Prados MD, Chang S, Weaver KA, Spry L, Malec MK, Lamb SA, Voss B, Davis RL, Wara WM, Larson DA, Phillips TL, Gutin PH (1998) Survival benefit of hyperthermia in a prospective randomized trial of brachytherapy boost ± hyperthermia for glioblastoma multiforme. Int J Radiat Oncol Biol Phys 40:287–295

  83. Somaza SC, Kondziolka D, Lunsford LD, Flickinger JC, Bissonette DJ, Albright AL (1996) Early outcomes after stereotactic radiosurgery for growing pilocytic astrocytomas in children. Pediatr Neurosurg 25:109–115

  84. Souhami L, Scott C, Brachman D, Podgorsak E, Werner-Wasik M, Lustig R, Schultz CJ, Sause W, Okunieff P, Buckner J, Zamorano L, Mehta M, Curran W (2002) Randomized prospective comparison of stereotactic radiosurgery (SRS) followed by conventional radiotherapy (RT) with BCNU to RT with BCNU alone for selected patients with supratentorial Glioblastoma Multiforme (GBM): report of RTOG 93–05 protocol. Int J Radiat Oncol Biol Phys 54(Suppl):94–95

  85. Stea B, Kittelson J, Cassady JR, Hamilton A, Guthkelch N, Lulu B, Obbens E, Rossman K, Shapiro W, Shetter A et al (1992) Treatment of malignant gliomas with interstitial irradiation and hyperthermia. Int J Radiat Oncol Biol Phys 24:657–667

  86. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996

  87. Tatter SB, Shaw EG, Rosenblum ML, Karvelis KC, Kleinberg L, Weingart J, Olson JJ, Crocker IR, Brem S, Pearlman JL, Fisher JD, Carson K, Grossman SA (2003) An inflatable balloon catheter and liquid 125I radiation source (GliaSite Radiation Therapy System) for treatment of recurrent malignant glioma: multicenter safety and feasibility trial. J Neurosurg 99:297–303

  88. Tselis N, Kolotas C, Birn G, Roddiger S, Filipowicz I, Kontova M, Fountzilas G, Selviaridis P, Baltas D, Heyd R, Anagnostopoulos G, Zamboglou N (2007) CT-guided interstitial HDR brachytherapy for recurrent glioblastoma multiforme. Long-term results. Strahlenther Onkol 183:563–570

  89. Videtic GM, Gaspar LE, Zamorano L, Fontanesi J, Levin KJ, Kupsky WJ, Tekyi-Mensah S (1999) Use of the RTOG recursive partitioning analysis to validate the benefit of iodine-125 implants in the primary treatment of malignant gliomas. Int J Radiat Oncol Biol Phys 45:687–692

  90. Vitaz TW, Warnke PC, Tabar V, Gutin PH (2005) Brachytherapy for brain tumors. J Neurooncol 73:71–86

  91. Walker MD, Alexander E Jr, Hunt WE, MacCarty CS, Mahaley MS Jr, Mealey J Jr, Norrell HA, Owens G, Ransohoff J, Wilson CB, Gehan EA, Strike TA (1978) Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 49:333–343

  92. Welsh J, Sanan A, Gabayan AJ, Green SB, Lustig R, Burri S, Kwong E, Stea B (2007) GliaSite brachytherapy boost as part of initial treatment of glioblastoma multiforme: a retrospective multi-institutional pilot study. Int J Radiat Oncol Biol Phys 68:159–165

  93. Zamorano L, Yakar D, Dujovny M, Sheehan M, Kim J (1992) Permanent iodine-125 implant and external beam radiation therapy for the treatment of malignant brain tumors. Stereotact Funct Neurosurg 59:183–192

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Correspondence to Xiang Zhang.

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B.-L. Liu and J.-X. Cheng contributed equally to this work

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Liu, B., Cheng, J., Zhang, X. et al. Controversies concerning the application of brachytherapy in central nervous system tumors. J Cancer Res Clin Oncol 136, 173–185 (2010). https://doi.org/10.1007/s00432-009-0741-y

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  • CNS tumors
  • Glioma
  • Brachytherapy
  • Radiotherapy