Intraoperative brachytherapy for resected brain metastases

Mahase, Sean S.; Navrazhina, Kristina; Schwartz, Theodore H.; Parashar, Bhupesh; Wernicke, A. Gabriella

doi:10.1016/j.brachy.2019.01.011

Cited by 18 publications

(20 citation statements)

References 73 publications

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“…Brachytherapy for recurrent brain tumors can be divided into two primary techniques: interstitial and intracavitary. With interstitial therapy, radiation sources are temporarily or permanently inserted directly into the tumor using stereotactic techniques [9][10]. The most common method involves the transcranial stereotactic placement of catheters in the tumor.…”

Section: Discussionmentioning

confidence: 99%

“…The most common method involves the transcranial stereotactic placement of catheters in the tumor. The catheters are secured to the scalp and then after loaded with Ir-192/I-125 seeds to deliver a prescription dose of 40 to 50 Gy to the tumor margin [9]. When the source is Ir-192, the prescription dose is given in 5 Gy fractions twice per day, while with I-125, the seeds are left in place continuously for 42 days before explanting the catheters [9].…”

Section: Discussionmentioning

confidence: 99%

“…Modern brachytherapy for brain tumors can be essentially divided into two categories: interstitial and intracavitary techniques [9][10]. Both techniques require close cooperation between the neurosurgery and radiation oncology teams.…”

Section: Introductionmentioning

confidence: 99%

“…Both techniques require close cooperation between the neurosurgery and radiation oncology teams. With interstitial therapy, radiation sources are inserted directly into the tumor using stereotactic techniques and left permanently in place or removed after the prescribed dose has been delivered [9]. With intracavitary brachytherapy, the patient undergoes craniotomy with maximum safe resection of the tumor followed by placement of a radiation source(s) directly along the walls of the tumor cavity [9].…”

Section: Introductionmentioning

confidence: 99%

“…With interstitial therapy, radiation sources are inserted directly into the tumor using stereotactic techniques and left permanently in place or removed after the prescribed dose has been delivered [9]. With intracavitary brachytherapy, the patient undergoes craniotomy with maximum safe resection of the tumor followed by placement of a radiation source(s) directly along the walls of the tumor cavity [9]. The intracavitary placement of permanent sources at the time of resection has the added benefit of initiating radiation therapy immediately and at a time when tumor burden has been surgically minimized.…”

Section: Introductionmentioning

confidence: 99%

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

Choi¹,

Zabramski

2020

Cureus

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We aim to compare the efficacy and toxicity of re-irradiation using brachytherapy for patients with locally recurrent brain tumors after previous radiation therapy. Methods We performed a systematic review of the major biomedical databases from 2005 to 2020 for eligible studies where patients were treated with re-irradiation for recurrent same site tumors using brachytherapy. Tumor types included high-grade gliomas (HGG) (World Health Organization (WHO) Grades 3 and 4), meningiomas, and metastases. The outcomes of interest were median overall survival (OS) and progressionfree survival (PFS) after re-irradiation, the incidence of radiation necrosis (RN), and other relevant radiation-related adverse events (AE). We used a fixed-effect meta-analysis regression moderation model to compared results of interstitial versus intracavitary therapy, treatment with low-dose-rate (LDR) versus high-dose-rate (HDR) techniques, and outcomes by tumor type. Results The search resulted in a total of 194 articles. A total of 16 articles with 695 patients fulfilled the inclusion criteria and were selected for analysis. For high-grade glioma, meningioma, and brain metastasis the pooled meta-analysis showed mean symptomatic RN rates of 3.3% (standard error (SE) = 0.8%), 17.3% (SE = 5.0%), and 22.4% (SE = 7.0%), respectively, and mean rates of RN requiring surgical intervention of 3.0% (SE = 1.0%), 11.9% (SE = 5.3%), and 10.0% (SE = 7.3%), respectively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Choi¹,

Zabramski

2020

Cureus

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Patient‐specific radiological protection precautions following Cs collagen embedded Cs‐131 implantation in the brain

Prasad

Dauer

Chu

et al. 2022

J Applied Clin Med Phys

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Objective: Cesium-131 brachytherapy is an adjunct for brain tumor treatment, offering potential clinical and radiation protection advantages over other isotopes including iodine-125. We present evidence-based radiation safety recommendations from an initial experience with Cs-131 brachytherapy in the resection cavities of recurrent, previously irradiated brain metastases. Methods: Twenty-two recurrent brain metastases in 18 patients were resected and treated with permanent Cs-131 brachytherapy implantation using commercially procured seed-impregnated collagen tiles (GammaTile, GT Medical Technologies). Exposure to intraoperative staff was monitored with NVLAPaccredited ring dosimeters.For patient release considerations,NCRP guidelines were used to develop an algorithm for modeling lifetime exposure to family and ancillary staff caring for patients based on measured dose rates. Results: A median of 16 Cs-131 seeds were implanted (range 6-46) with median cumulative strength of 58. 72U (20.64-150.42). Resulting dose rates were 1.19 mSv/h (0.28-3.3) on contact, 0.08 mSv/h (0.01-0.35) at 30 cm, and 0.01 mSv/h (0.001-0.03) at 100 cm from the patient. Modeled total caregiver exposure was 0.91 mSv (0.16-3.26), and occupational exposure was 0.06 mSv (0.02-0.23) accounting for patient self -shielding via skull and soft tissue attenuation. Real-time dose rate measurements were grouped into brackets to provide close contact precautions for caregivers ranging from 1-3 weeks for adults and longer for pregnant women and children, including cases with multiple implantations. Conclusions: Radiological protection precautions were developed based on patient-specific emissions and accounted for multiple implantations of Cs-131, to maintain exposure to staff and the public in accordance with relevant regulatory dose constraints.

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