Imaging After GliaSite Brachytherapy: Prognostic MRI Indicators of Disease Control and Recurrence

Kleinberg, Lawrence; Yoon, Geoffrey; Weingart, John; Parisi, Michele; Olivi, Alessandro; Detorie, Nicholas; Chan, Timothy A.

doi:10.1016/j.ijrobp.2008.12.074

Cited by 12 publications

(5 citation statements)

References 24 publications

(28 reference statements)

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“…This limited survival data suggests that this treatment may have been active and is worthy of further study. The median survival was 15.3 months for NEW-GBM patients and 12.8 months for recurrent disease similar to other reports using this device [4, 16–19] (Table 1), although well-powered prospective trial has not occurred. Temozolomide chemotherapy, now standard in the management of newly diagnosed glioblastoma, was not utilized.…”

Section: Discussionsupporting

confidence: 86%

“…An analysis of outcome for 20 patients treated with GliaSite brachytherapy for recurrent disease at Johns Hopkins confirmed the observation that imaging changes, including substantially increased contrast enhancement, are not correlated with survival and may therefore represent benign treatment-related effects rather than progressive tumor for some patients [16]. Eighty percent had an imaging confirmed gross total resection, and routine MRIs through 3 months of follow-up were assessed.…”

Section: Discussionmentioning

confidence: 89%

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Outcome of Adult Brain Tumor Consortium (ABTC) prospective dose-finding trials of I-125 balloon brachytherapy in high-grade gliomas: challenges in clinical trial design and technology development when MRI treatment effect and recurrence appear similar

Kleinberg

Stieber²,

Mikkelsen

et al. 2015

J Radiat Oncol

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Objectives The aim of this study is to define the maximal safe radiation dose to guide further study of the GliaSite balloon brachytherapy (GSBT) system in untreated newly diagnosed glioblastoma (NEW-GBM) and recurrent high-grade glioma (REC-HGG). GBST is a balloon placed in the resection cavity and later filled through a subcutaneous port with liquid I-125 Iotrex, providing radiation doses that diminish uniformly with distance from the balloon surface. Methods The Adult Brain Tumor Consortium initiated prospective dose-finding studies to determine maximum tolerated dose in NEW-GBM treated before standard RT or after surgery for REC-HGG. Patients were inevaluable if there was progression before the 90-day posttreatment toxicity evaluation point. Results Ten NEW-GBM patients had the balloon placed, and 2/10 reached the 90 day timepoint. Five REC-HGG enrolled and two were assessable at the 90-day evaluation endpoint. Imaging progression occurred before 90-day evaluation in 7/12 treated patients. The trials were closed as too few patients were assessable to allow dose escalation, although no dose-limiting toxicities (DLTs) were observed. Median survival from treatment was 15.3 months (95 % CI 7.1–23.6) for NEW-GBM and 12.8 months (95 % CI 4.2–20.9) for REC-HGG. Conclusion These trials failed to determine a maximum tolerated dose (MTD) for further testing as early imaging changes, presumed to be progression, were common and interfered with the assessment of treatment-related toxicity. The survival outcomes in these and other related studies, although based on small populations, suggest that GSBT may be worthy of further study using clinical and survival endpoints, rather than standard imaging results. The implications for local therapy development are discussed.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 89%

Outcome of Adult Brain Tumor Consortium (ABTC) prospective dose-finding trials of I-125 balloon brachytherapy in high-grade gliomas: challenges in clinical trial design and technology development when MRI treatment effect and recurrence appear similar

Kleinberg

Stieber²,

Mikkelsen

et al. 2015

J Radiat Oncol

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“…In one study, a total of 25 patients with recurrent GBM underwent repeat resection and subsequent GliaSite brachytherapy [66]. After brachytherapy, all patients developed some degree of enhancement around the resection cavity on T1 and T2/FLAIR imaging.…”

Section: Radiation Treatment Effect In Various Radiation Modalitiesmentioning

confidence: 99%

“…In contrast, those with T1 enhancement under 1 cm before clinical progression had a median survival of 8.4 months (p = 0.004). The subset of patients with T1 enhancement over 1 cm with a concomitant increase in T2 hyperintensity had a median survival of only 10.1 months, suggesting that the development of T1-postcontrast enhancement alone (without T2 hyperintensity) did not necessarily indicate disease progression and may have been an indication of a positive effect of treatment [66]. Clinical trials to optimize the dosing with this device were discontinued as it was felt there was a high rate of early progression.…”

Section: Radiation Treatment Effect In Various Radiation Modalitiesmentioning

confidence: 99%

Postradiation Imaging Changes in the CNS: How can we Differentiate Between Treatment Effect and Disease Progression?

et al. 2014

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A familiar challenge for neuroradiologists and neuro-oncologists is differentiating between radiation treatment effect and disease progression in the CNS. Both entities are characterized by an increase in contrast enhancement on MRI and present with similar clinical signs and symptoms that may occur either in close temporal proximity to the treatment or later in the disease course. When radiation-related imaging changes or clinical deterioration are mistaken for disease progression, patients may be subject to unnecessary surgery and/or a change from otherwise effective therapy. Similarly, when disease progression is mistaken for treatment effect, a potentially ineffective therapy may be continued in the face of progressive disease. Here we describe the three types of radiation injury to the brain based on the time to development of signs and symptoms – acute, subacute and late – and then review specific imaging changes after intensity-modulated radiation therapy, stereotactic radiosurgery and brachytherapy. We provide an overview of these phenomena in the treatment of a wide range of malignant and benign CNS illnesses. Finally, we review the published data regarding imaging techniques under investigation to address this well-known problem.

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“…33 Brachytherapy and stereotactic surgical therapies are typically reserved for relapsed GBM and provide some additional survival benefits. [34][35][36] Despite the general avoidance of transarterial embolic treatment in the brain, 90 Y may provide some benefits over EBRT in that it can deliver higher doses of radiation to metastases that exceeds that of EBRT. Furthermore, superselectively delivered TARE may minimize nontarget radiation as the average tissue penetration is 2.4 mm, compared with 3 to 4 cm in brachytherapy or up to the entire cerebral cortex in EBRT.…”

Section: Rationalementioning

confidence: 99%

Radioembolization Outside of the Liver

Tanaka

Wehrenberg-Klee

2021

Digestive Disease Interventions

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Transarterial radioembolization (TARE) with yttrium-90 microspheres has emerged as an effective therapy for the treatment of both primary and metastatic hepatic lesions. It has been studied most extensively in hepatocellular carcinoma (HCC) and metastatic colorectal lesions (mCRC). The clinical success of TARE in HCC and mCRC has led to further investigation of expanding treatment to other malignancies involving the liver such as neuroendocrine carcinoma, uveal melanoma, and breast carcinoma, among others. Furthermore, interest in applications of TARE outside of the liver is emerging and small initial studies have been performed primarily in animal models to assess the effects of TARE on other organs such as the brain, stomach, spleen, kidney, and lungs. This review summarizes existing literature on the use of TARE outside of the liver.

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Imaging After GliaSite Brachytherapy: Prognostic MRI Indicators of Disease Control and Recurrence

Cited by 12 publications

References 24 publications

Outcome of Adult Brain Tumor Consortium (ABTC) prospective dose-finding trials of I-125 balloon brachytherapy in high-grade gliomas: challenges in clinical trial design and technology development when MRI treatment effect and recurrence appear similar

Outcome of Adult Brain Tumor Consortium (ABTC) prospective dose-finding trials of I-125 balloon brachytherapy in high-grade gliomas: challenges in clinical trial design and technology development when MRI treatment effect and recurrence appear similar

Postradiation Imaging Changes in the CNS: How can we Differentiate Between Treatment Effect and Disease Progression?

Radioembolization Outside of the Liver

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