Purpose
External-beam radiotherapy (EBRT) is the predominant method for localized brain radiotherapy (LBRT) after resection of brain metastases (BM). Intraoperative radiotherapy (IORT) with 50-kV x‑rays is an alternative way to focally irradiate the resection cavity after BM surgery, with the option of shortening the overall treatment time and limiting normal tissue irradiation.
Methods
We retrospectively analyzed the outcomes of all patients who underwent neurosurgical resection of BM and 50-kV x‑ray IORT between 2013 and 2020 at Augsburg University Medical Center.
Results
We identified 40 patients with 44 resected BM treated with 50-kV x‑ray IORT. Median diameter of the resected metastases was 2.8 cm (range 1.5–5.9 cm). Median applied dose was 20 Gy. All patients received standardized follow-up (FU) including 3‑monthly MRI of the brain. Mean FU was 14.4 months, with a median MRI FU for alive patients of 12.2 months. Median overall survival (OS) of all treated patients was 26.4 months (estimated 1‑year OS 61.6%). The observed local control (LC) rate of the resection cavity was 88.6% (estimated 1‑year LC 84.3%). Distant brain control (DC) was 47.5% (estimated 1‑year DC 33.5%). Only 25% of all patients needed WBI in the further course of disease. The observed radionecrosis rate was 2.5%.
Conclusion
IORT with 50-kV x‑rays is a safe and appealing way to apply LBRT after neurosurgical resection of BM, with low toxicity and excellent LC. Close MRI FU is paramount to detect distant brain failure (DBF) early.
Purpose External beam radiotherapy (EBRT) is the predominant method for localized brain radiotherapy (LBRT) after resection of brain metastases (BM). Intraoperative radiotherapy (IORT) with 50kV x-rays is an alternative way to irradiate the resection cavity focally after BM surgery with the option to shorten the overall treatment time and limit normal tissue irradiation.Methods We retrospectively analyzed the outcomes of all patients who underwent neurosurgical resection of BM and 50kV x-ray IORT between 2013 and 2020 at Augsburg University Medical Center.Results We identified 40 patients with 44 resected BM treated with 50kV x-ray IORT. Median diameter of the resected metastases was 2.8 cm (range 1.5–5.9 cm). Median applied dose was 20 Gy. All patients received standardized follow-up (FU) including 3-monthly MRI of the brain. Mean FU was 14.4 months, with a median MRI FU for patients alive of 12.2 months. Median overall survival (OS) of all treated patients was 26.4 months (estimated 1-year OS 61.6%). The observed local control (LC) rate of the resection cavity was 88.6% (estimated 1-year LC 84.3%). Distant brain control (DC) was 47.5% (estimated 1-year DC 33.5%). Only 25% of all patients needed WBI in the further course of disease. The observed radionecrosis rate was 2.5%.Conclusion IORT with 50kV x-rays is a safe and appealing way to apply LBRT after neurosurgical resection of BM with low toxicity and excellent LC. Close MRI FU is paramount to detect distant brain failure (DBF) early.
Rhabdoid tumor with predisposition syndrome 1 is a highly aggressive,
rare genetic condition in young children. We report an 18-month-old
child with bleeding from a second local recurrence of an orbital
rhabdoid tumor. Due to the rarity of the syndrome there are no generally
accepted treatment approaches, especially in tumor recurrences. As a
rescue therapy, our patient received a combination of transarterial
embolization and interstitial brachytherapy (BT). From the initiation of
our treatment until his death, he experienced neither recurrent bleeding
nor local tumor recurrence. The combination of embolization and BT might
offer a safe palliative approach and could be considered as a possible
alternative at an earlier stage.
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