Experience of Using the INTRABEAM System to Determine the Safely Tolerated Dose During Intraoperative Irradiation of Malignant Gliomas

Abstract

Glioblastoma is the  most malignant primary brain  tumor. For treatment uses a combined regimen that is currently available:  surgery,  radiation and chemotherapy. However,  so far the median survival  of patients does not exceed 14 months. In this connection, there  is a constant search for effective methods. Improvement in radiation therapy has led to the possibility of its intraoperative, which  is a practical and effective  method aimed at getting rid of the remaining tumor cells, reducing the spread of the tumor and filling the therapeutic gap between surgery  and subsequent chemotherapy and radiation therapy. Intraoperative radiation therapy (IORT) allows  you to  deliver  the  required tumoricidal dose  exactly  to  the  target, minimally affecting the surrounding healthy tissues.Goal: Establishment of the  safety of intraoperative irradiation of patients with  malignant gliomas  with the INTRABEAM  device (Carl ZEISS, Germany) with a dose of up to 40 Gy on the applicator.Material and methods: The study  involved  15 patients, the average  age of which  was 51 years, the ratio of  men  and  women  was  4:6, the  average  Karnofsky index  before  surgery  was  97. After  surgical removal of the  tumor, an  express  biopsy  was performed. Next,  intraoperative irradiation was performed with  the INTRABEAM  device (Carl ZEISS) at a dose of 40 Gy, followed by an assessment of the Karnofsky index, early postoperative and delayed possible complications.Results:  In all patients operated on with  intraoperative irradiation and subsequent adjuvant radiochemotherapy, the  method was  well  tolerated, there  were  no  wound  healing features or  identified complications, there  were no cases of wound  liquorrhea, wound  inflammation.Conclusion: Intraoperative irradiation after surgical removal of the tumor can be recommended as a safe method for the treatment of malignant gliomas  in addition to existing combination therapy.