Salvage SBT is feasible and safe even after previously performed external beam radiation. Favorable outcome measurements in particular for grade III recurrences deserve further prospective evaluation.
SBT combines diagnostic yield with effective treatment in selected patients. The low toxicity rate in the salvage group points to protective radiobiologic characteristics of continuous low-dose rate irradiation. Upfront and salvage SBT are similarly effective and safe. Histologic reevaluation should be reconsidered after previous radiotherapy to avoid under- or overtreatment.
An interesting and distinctive group were the cases where histology showed portal fibrosis without definite cirrhosis. The majority of the cases were treated by portacaval shunt of the end-to-end variety.The overall mortality, including short-and longterm mortality, was 27 per cent Of the portacaval group, the total mortality was 29 per cent. The incidence of post-shunt neuropathy syndrome was 23.6 per cent. Postoperative haemorrhagic complications were most marked in the splenorenal and splenectomy groups and were very low in the portacaval shunt group. The cases were followed up over many years. It was seen that in the portacaval shunt group, a large majority of the deaths occurred in the first year. This was not so in the other groups. Haemodynamic studies following portacaval shunt showed that the wedged hepatic venous pressure was reduced by about 6 mm. Hg and the hepatic blood-flow by about 30 per cent. Lowering of the blood-flow by 50 per cent or more was associated with marked neuropathic symptoms.A c k n o w l e d g e m e n t s . -W e are grateful to
Background
This long-term retrospective analysis aimed to investigate the outcome and toxicity profile of stereotactic brachytherapy (SBT) in selected low-grade gliomas WHO grade II (LGGII) in a large patient series.
Methods
This analysis comprised 106 consecutive patients who received SBT with temporary Iodine-125 seeds for histologically verified LGGII at the University of Munich between March 1997 and July 2011. Investigation included clinical characteristics, technical aspects of SBT, the application of other treatments, outcome analyses including malignization rates, and prognostic factors with special focus on molecular biomarkers.
Results
For the entire study population, the 5- and 10-years overall survival (OS) rates were 79% and 62%, respectively, with a median follow-up of 115.9 months. No prognostic factors could be identified. Interstitial radiotherapy was applied in 51 cases as first-line treatment with a median number of two seeds (range 1–5), and a median total implanted activity of 21.8 mCi (range 4.2–43.4). The reference dose average was 54.0 Gy. Five- and ten-years OS and progression-free survival rates after SBT were 72% and 43%, and 40% and 23%, respectively, with a median follow-up of 86.7 months. The procedure-related mortality rate was zero, although an overall complication rate of 16% was registered. Patients with complications had a significantly larger tumor volume (p = 0.029).
Conclusion
SBT is a minimally invasive treatment modality with a favorable outcome and toxicity profile. It is both an alternative primary treatment method as well as an adjunct to open tumor resection in selected low-grade gliomas.
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