Stereotaxic techniques may be used in combination with interstitial or external beam radiotherapy for the treatment of intracranial malignancies. At the University of California, San Francisco, temporary, high-activity, iodine 125 sources are used mainly for the treatment of malignant gliomas. Patients with unifocal lesions that are smaller than 5 to 6 cm have discrete margins on computed tomography (CT) limited to supratentorial regions are selected for stereotaxic implantation. Both primary and recurrent malignant gliomas are treated with stereotaxic implantation; primary malignant gliomas are treated in addition with nonstereotaxic external beam radiotherapy and concomitant and sequential chemotherapy. Median survival times measured from the time of implantation are as follows: primary glioblastoma multiforme, 95 weeks; recurrent glioblastoma multiforme, 54 weeks; primary anaplastic astrocytoma, 223 weeks; and recurrent anaplastic astrocytoma, 81 weeks. Stereotaxic interstitial brachytherapy in conjunction with hyperthermia (thermoradiotherapy) is being studied in the treatment of recurrent or metastatic intracranial malignancy. External beam radiotherapy delivered stereotaxically in a single fraction (radiosurgery) has been used mainly for benign intracranial processes, although several centers are now exploring its use in the management of highly selected malignant lesions. Although its role is not yet completely defined, it may prove useful in highly selected subsets of patients with small intracranial malignancies, whether primary, recurrent, or metastatic.
