Treatment of Malignant Glioma in the Basal Ganglia with Hyperthermia and Radiotherapy

Abstract

We staged the Malignant gliomas in the thalamus and basal ganglia seen at one institution over a 20-year period were staged, and the clinical features of hyperthermic treatment in these site were examined.
The subjects in this study were inpatients who received treatments at Niigata University. There were 43 patients with grade 3 or 4 glioma in the basal ganglia (24 patients in the thalamus and 19 patients in the putamen). For staging, tumors in the thalamus and putamen were classified by their sizes : less than 2 cm, 2-4 cm, and greater than 4 cm were classified as stages 1 to 3. Tumors which progressed outside of the basal ganglia were classified as stage 4, and those which progressed to the ventricle were classified as stage 5.
The percentage of patients in stage 4 whose tumor invaded to the internal capsule or midbrain was 30%, and this percentage reached 40% when combined with patients in stage 5. Resection was performed in 14 patients. Tumors of the 29 remaining patients were biopsied. In 14 of the biopsied cases, needle electrodes were implanted in the tumors, and interstitial hyperthermia was performed. The electrodes (RF antennas) were stereotactically implanted in the tumor under local anesthesia simultaneously with biopsy. The heating strategy used was to control the RF output in order to heat the rim of the tumor up to a temperature of 43°C for a 40-60 minute heating period. The heating procedure was repeated twice a week for a total of 3 to 4 times, and combined with conventional radiation therapy with a dose of 50-60 Gy, and MCNU or ACNU chemotherapy.
The Median Survival Time (MST) for overall survival was 11 months (thalamic cases : 17 months ; putamen cases : 11 months). The MST for cases receiving hyperthermia was 22 months, and for cases which did not receive hyperthermia, the MST was 9 months.
Few malignant gliomas in the basal ganglia were removed with surgery because of their localization. In more than a few cases, local treatments were difficult and the prognosis was poor. However, there were responsive cases among the patients who underwent hyperthermia.