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Background and objectives <p>Local control remains a challenge in the treatment of recurrent glioblastomas. Our prior experience indicates that adjunctive cesium-131 brachytherapy, followed by systemic therapy, is a promising option. Here, we extend the initial findings through a multi-institutional study.</p> Methods <p>Clinical information was collected for consecutive, recurrent glioblastoma (isocitrate dehydrogenase wild-type) patients treated at seven participating institutions. All patients underwent systemic treatment after surgical resection/cesium implant. Median progression-free and overall survival (mPFS and mOS) were calculated from the time of cesium tile implantation.</p> Results <p>The study cohort comprised 43 male and 17 female subjects, with a median of 1 prior glioblastoma recurrence. The mean pre-operative Karnofsky Performance Score (KPS) was 80 (<i>±</i> 15.7). There was one case (2%) of postoperative hemorrhage, one case (2%) of wound breakdown, and one case (2%) of radiation necrosis. The median hospital stay was 2 days (IQR: 2, 4 days). Ten patients in the cohort (16.7%) required 30-day readmission. With a median follow-up of 400 days, the actuarial local control at one year was 88.6% and 79% for MGMT-methylated and -unmethylated patients, respectively (<i>p</i> = 0.17). MGMT-methylated patients showed improved OS (mOS = 487 days (16.2 months)) relative to unmethylated patients (mOS = 244 days (8.1 months), <i>p</i> &lt; 0.001). Notably, patients with postoperative KPS decline showed reduced OS relative to those with stable/improved KPS (mOS of 420 vs. 218 days, respectively, <i>p</i> = 0.008). Patients who adopted the ketogenic diet showed improved OS relative to those who did not (mOS of 451 vs. 239 days, respectively, <i>p</i> = 0.01). There was no statistically significant association between tumor recurrence or prior bevacizumab use and outcomes.</p> Conclusion <p>This multi‑institutional experience provides evidence supporting the continued development of cesium tile therapy as a treatment option for recurrent glioblastoma.</p>

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Evaluating the safety and efficacy of adjunctive cesium 131-tile brachytherapy in recurrent glioblastoma patients: a multi-institutional collaborative

  • 期刊论文

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  • 发表日期：

    2026年5月13日

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  • Carlin Chuck,
  • Alice Lin,
  • Joseph Oldam,
  • Elaina J. Wang,
  • Mazen Taman,
  • Abigail Teshome,
  • Hsien-Chung Chen,
  • Trenton Kite,
  • Sean Peach,
  • Mark J. Rivard,
  • Stuart Lee,
  • Kimberly B. Hoang,
  • Matthew Shepard,
  • Sabrina Zeller,
  • Rohil Shekher,
  • Eric T. Wong,
  • Sasmit Sarangi,
  • Heinrich Elinzano,
  • Simon Hanft,
  • Daniel Kim,
  • Clara Ferreira,
  • Kris A. Smith,
  • Clark C. Chen

摘要

Background and objectives

Local control remains a challenge in the treatment of recurrent glioblastomas. Our prior experience indicates that adjunctive cesium-131 brachytherapy, followed by systemic therapy, is a promising option. Here, we extend the initial findings through a multi-institutional study.

Methods

Clinical information was collected for consecutive, recurrent glioblastoma (isocitrate dehydrogenase wild-type) patients treated at seven participating institutions. All patients underwent systemic treatment after surgical resection/cesium implant. Median progression-free and overall survival (mPFS and mOS) were calculated from the time of cesium tile implantation.

Results

The study cohort comprised 43 male and 17 female subjects, with a median of 1 prior glioblastoma recurrence. The mean pre-operative Karnofsky Performance Score (KPS) was 80 (± 15.7). There was one case (2%) of postoperative hemorrhage, one case (2%) of wound breakdown, and one case (2%) of radiation necrosis. The median hospital stay was 2 days (IQR: 2, 4 days). Ten patients in the cohort (16.7%) required 30-day readmission. With a median follow-up of 400 days, the actuarial local control at one year was 88.6% and 79% for MGMT-methylated and -unmethylated patients, respectively (p = 0.17). MGMT-methylated patients showed improved OS (mOS = 487 days (16.2 months)) relative to unmethylated patients (mOS = 244 days (8.1 months), p < 0.001). Notably, patients with postoperative KPS decline showed reduced OS relative to those with stable/improved KPS (mOS of 420 vs. 218 days, respectively, p = 0.008). Patients who adopted the ketogenic diet showed improved OS relative to those who did not (mOS of 451 vs. 239 days, respectively, p = 0.01). There was no statistically significant association between tumor recurrence or prior bevacizumab use and outcomes.

Conclusion

This multi‑institutional experience provides evidence supporting the continued development of cesium tile therapy as a treatment option for recurrent glioblastoma.