GammaTile ^® : Surgically targeted radiation therapy for glioblastomas

Abstract

<jats:p> Glioblastoma is the most common primary malignant neoplasm of the central nervous system in adults. Standard of care is resection followed by chemo-radiation therapy. Despite this aggressive approach, &gt;80% of glioblastomas recur in proximity to the resection cavity. Brachytherapy is an attractive strategy for improving local control. GammaTile<jats:sup>®</jats:sup> is a newly US FDA-cleared device which incorporates <jats:sup>131</jats:sup>Cs radiation emitting seeds in a resorbable collagen-based carrier tile for surgically targeted radiation therapy to achieve highly conformal radiation at the time of surgery. Embedding encapsulated <jats:sup>131</jats:sup>Cs radiation emitter seeds in collagen-based tiles significantly lowers the technical barriers associated with traditional brachytherapy. In this review, we highlight the potential of surgically targeted radiation therapy and the currently available data for this novel approach. </jats:p>

Re-Irradiation Using Brachytherapy for Recurrent Intracranial Tumors: A Systematic Review and Meta-Analysis of the Literature

“…Proper spacing of seeds is critical for delivering a safe, effective, and uniform dose of radiation. Recently, a novel brachytherapy device, GammaTile® (GT Medical Technologies, Inc., Tempe, AZ), has become clinically available which minimizes these technical issues [6]. This device consists of Cs-131 seeds positioned 1 cm apart within a collagen carrier tile.…”

“…While re-irradiation can potentially prolong survival in patients with recurrent brain tumors, its use has been limited due to concerns of increased risks of toxicity to surrounding normal brain, particularly when the recurrent lesion lies within a previous field of treatment [3][4]. Re-irradiation using brachytherapy may provide a safer alternative in such cases [3,[5][6][7].…”

“…Despite its potential advantages, brachytherapy is rarely used in the management of recurrent brain tumors largely due to the technical demands of treatment, and the high rates of radiation necrosis reported with the traditional isotope, I-125. More recently, a novel surgically targeted radiation therapy (STaRT) brachytherapy device has become clinically available that minimizes the technical issues associated with intracavitary brachytherapy [6]. This device consists of Cs-131 seeds positioned 1 cm apart within a collagen carrier tile that is permanently implanted at the time of surgery, typically taking less than 5 minutes to place.…”

Novel Treatment Strategies for Glioblastoma

“…Interstitial brachytherapy which requires the placement of radioactive isotopes (or seeds) into the surgical cavity is not an entirely new treatment, but due to continuing concerns such as radiation leakage into the surrounding brain, efforts into improving brachytherapy are underway, including the prolonged delivery of higher doses of radiation, use of alternative isotopes, and targeted delivery via the combination of isotopes with monoclonal antibodies. A treatment known as GammaTile, which involves inserting encapsulated radioactive cesium-131 seeds into the surgical cavity, was recently approved by the FDA for the treatment of GBM and has to date demonstrated feasibility and safety [ 50 ].…”

Feasibility of removable balloon implant for simultaneous magnetic nanoparticle heating and HDR brachytherapy of brain tumor resection cavities

“…Optimum treatment of GBM remains a controversial subject. Clinical trials have investigated numerous combinations of external beam radiation, systemic chemotherapy [2,20], focused stereotactic radiosurgery [21], local radiation boost to tumor bed via interstitial implant [22,23], GammaTile therapy [24], local chemotherapy (e.g., carmustine or Gliadel V R wafers) [16,17,19,25,26] and/or immunotherapy [27,28]. Additionally, several trials have investigated local hyperthermia as a means to enhance radiation response while minimizing peripheral normal tissue toxicity [16,17,19].…”