Basic Pinciples of Brachycurietherapy of Brain Tumors

Abstract

Interstitial brain irradiation for primary malignant brain tumors is not a new technique but has only recently attained clinical significance due to the newly developed ability to perform stereotactic localization and biopsies (Mundinger et al. 1978; Szikla et al. 1979; Gutin et al. 1981). Primary cerebral neoplasms are well suited to a local strategy using radiation for tumor control since (1) extraneural metastases are uncommon, (2) the majority of the lesions that recur do so within 2 cm of their site of origin, (3) more than 90% of anaplastic astrocytomas and glioblastomas are localized to one side of the brain (Hochberg and Pruitt 1980), (4) tumors are not always amenable to open surgical decompression or extensive cytoreduction because of their anatomic location, (5) when surgery cannot be performed, the most effective adjunct has clearly been proven to be radiation, (6) both chemotherapy and chemical modifiers (sensitizers/protectors) have been shown to be ineffective (Walker et al. 1978), (7) it is still too early to identify the clinical efficacy of hyperthermia in the treatment of these tumors, and (8) the results of novel fractionation schemes are still to be determined.