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KMID : 0942820020010020102
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Journal of Korean Brain Tumor Society
2002 Volume.1 No. 2 p.102 ~ p.106
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Intraoperative Irradiation for Brain Tumors
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Kim Chul-Yong
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Abstract
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High-grade malignant gliomas are the most common brain tumors of the adult and about 30-45% of the primary brain tumors. The prognosis of high-grade malignant brain tumors is very poor. Surgical removal of tumor is a good treatment modality in brain tumors. The pattern of failure after surgery is almost local failure. Even in improving both local and systemic treatment, there is the local residual or recurrent tumors within 2-3cm of the primary site. Irradiation is the most effective adjuvant treatment modality and is therefore a mandatory treatment after maximal surgical removal for the highgrade malignant brain tumors. The benefit of postoperative irradiation has been reported in randomized clinical trials Brain Tumor Cooperative Group, Brain Tumor Study Group, and Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group). But there is still high local residual and/or recurrent tumor. Intraoperative irradiation(IORT) is an alternative treatment as loco-regional treatment for high-grade malignant brain tumors. The rationale for IORT is 1) tumor unifocality, 2) pattern of recurrence in or close to the primary site, 3) radiation dose-tumor response correlation, 4) to spare normal brain tissue from single large doses delivered directly into the tumor bed. IORT is an tolerable, feasible, and attractive treatment modality as an aggressive local procedure for malignant brain tumors. The published experiences suggested that IORT is an effective complement to surgery and conventional external irradiation in the loco-regional treatment for brain tumors and showed encouraging preliminary results as compared with historical conventional treatments, without an increase in side effects. Further study in IORT must investigate several factors such as the optimum dose, the combination of biological modulators, the precision of target tumor volume, the method to optimize the dose distribution into the tumor, and the accuracy in the delivery of the prescribed total dose.
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KEYWORD
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Intraoperative irradiation, High-grade malignant gliomas
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