Al's Comment:
Very impressive results with Gammatile for recurrent Glioblastoma. This is an FDA approved treatment that is widely (although not everywhere yet) available. If you are going to have a brain tumor surgery, ask your neurosurgeon about it. Surgery by itself doesn't really prolong survival much - adding Gammatiles at the time of surgery may significantly extend survival! We recently did a webinar about this: https://virtualtrials.org/video2021.cfm?video=202101
Posted on: 11/22/2021
(RADT-15) First experience with maximal safe resection and Gammatile brachytherapy as treatment for recurrent glioblastoma
Sunday, November 21, 2021
10:10 AM - 10:15 AM
Room: 208
Clark C. Chen, MD, PhD - University of Minnesota
Introduction: Gammatile (GT) is a recently FDA-cleared brachytherapy platform with 131Cs seeds imbedded into a resorbable collagen carrier for surgically targeted radiation delivery. We report the first experience for recurrent glioblastoma patients who underwent GT treatment following surgical resection.Methods: Twenty-two consecutive patients with 23 isocitrate dehydrogenase (IDH) wild-type glioblastomas (14 second; eight third recurrence) who underwent intra-operative MRI/5-ALA guided maximal safe resection followed by GT placement were prospectively followed. There were 6 methylguanine-DNA-methyltransferase promoter methylated (MGMTm) and 17 unmethylated (MGMTu) glioblastomas.
Results: The median hospital stay was one day (range:1-15 days). There was one 30-day readmission (4.5%) for a cerebrospinal fluid leak from the incision site, which resolved with lumbar drainage. There were no other wound complications. One patient (4.5%) suffered new post-operative seizure. Eight patients experienced worsened neurological deficit (8/22 or 36%). While all deficits improved by the 30-day follow-up, 7 of these 8 patients suffered KPS decline due to persistent deficits. There was one 30-day mortality (4.5%) from intracranial hemorrhage secondary to heparinization for an ischemic limb. The median follow-up after GT placement for the remaining 21 patients was 296 days (range:111-931 days). Six months local control (LC) was achieved in ~75% of the patients irrespective of MGMT status. Median overall survival (OS) was 715 days for the MGMTu patients, and not reached ( >1000 days) for MGMTm patients. These outcomes compared favorably to the published literature (LC: 3-49%; OS MGMTu: 135-285 days; OS MGMTm: 174-564 days) and an age, KPS, extent of resection matched glioblastoma cohort who underwent maximal safe resection without GT at our institution (LC: 52%; OS MGMTu: 462 days; OS MGMTm: 821 days; p=0.0089 and p=0.0271, respectively when compared to the GT treated patients).
Conclusion: This clinical experience supports the safety and efficacy of GT brachytherapy as a treatment option for recurrent glioblastomas.
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