Iodine-125 brachytherapy as upfront and salvage treatment for brain metastases

Romagna, Alexander; Schwartz, Christoph; Egensperger, Rupert; Watson, J. W.; Tonn, Jörg‐Christian; Belka, Claus; Kreth, Friedrich-Wilhelm; Nachbichler, Silke Birgit

doi:10.1007/s00066-016-1009-5

Cited by 10 publications

(9 citation statements)

References 27 publications

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“…28 Available treatment options range from supportive care alone to resection, WBRT, SRS, or even interstitial brachytherapy. 29 Considering that BVRR plus RPA class provided additional prognostic information compared with RPA class alone in our study, determining the patients' BVRR after WBRT in addition to their RPA class could help clinicians estimate their prognoses more reliably. In this regard, patients with a high RPA class and an increased BVRR would be best suited for best supportive care alone or treatments with a low side effect profile and a short treatment time like single SRS.…”

Section: Discussionmentioning

confidence: 79%

Brain volume reduction after whole-brain radiotherapy: quantification and prognostic relevance

et al. 2017

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Section: Discussionmentioning

confidence: 79%

Brain volume reduction after whole-brain radiotherapy: quantification and prognostic relevance

et al. 2017

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“…The lack of standardized treatment algorithms for these patients leads to a variety of individualized salvage treatment strategies [3]. Possible concepts consist of local treatment options (percutaneous radiotherapy/radiosurgery, open tumor resection (OTR), and low-activity iodine-125 brachytherapy (SBT) or systemic chemotherapy and/or any combinations thereof [3-6]. For salvage radiosurgery, a post-recurrence survival (PRS) range between 4.5 and 22.4 months - depending on the tumor entity - has been reported [7-8].…”

Section: Introductionmentioning

confidence: 99%

CyberKnife Radiosurgery in Recurrent Brain Metastases: Do the Benefits Outweigh the Risks?

Romagna¹,

Schwartz

Ladisich

et al. 2018

Cureus

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IntroductionLocal treatment concepts are in high demand in the salvage treatment of recurrent brain metastases. Still, their risks and benefits are scarcely characterized. In this study, we analyzed the outcome and risk-/benefit-ratio of salvage CyberKnife (Accuray Incorporated, Sunnyvale, California, US) radiosurgery in the treatment of recurrent brain metastases after whole brain radiotherapy (WBRT).Materials and methodsSeventy-six patients with 166 recurrent brain metastases and a multimodal pretreatment were retrospectively investigated. All patients underwent salvage CyberKnife radiosurgery (single fraction, reference dose: 17-22 Gy). Study endpoints were post-recurrence survival (PRS) after salvage treatment as well as local and distant tumor control rates. Central nervous system (CNS) toxicity was assessed according to the toxicity criteria of the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC)).ResultsThe population was homogenous regarding its demographic parameters. All patients had a history of WBRT prior to salvage CyberKnife radiosurgery. PRS was 13.3 months (10.4 - 16.2 months), one-year local and distant tumor control rates were 87% (95% CI: 75-99) and 38% (95% CI: 23-52), respectively. Eighteen patients suffered from RTOG/EORTC grade I/II toxicity. No toxicity-related risk factors were identified.DiscussionThis study found indicative survival and tumor control rates as well as a favorable risk/benefit ratio regarding radiotoxicity in salvage CyberKnife radiosurgery. These results point to a proactive therapeutic strategy based on appropriate patient selection instead of therapeutic nihilism.

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“…This trial illustrated the impressive effects of Cs-131 brachytherapy for patients but largely evaluated lesions that had not received prior irradiation. Romagna et al compared upfront and salvage I-125 brachytherapy across 48 cases and showed local control rates of 94% and 87%, respectively [ 24 ]. Raleigh et al showed a similar 90.5% rate of local control across 105 recurrent or large metastatic lesions for I-125 brachytherapy as well [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Metastatic Brain Lesions Treated with Radioactive Cs-131 Seeds after Surgery: Experience from One Institution

Xia

Mashouf

Baker

et al. 2018

Cureus

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IntroductionBrain metastases are common in patients with advanced systemic cancer and often recur despite treatment with surgical resection and radiotherapy. Whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) have significantly improved local control rates but are limited by complications including neurocognitive deficits and radiation necrosis. These risks can be higher in the re-irradiation setting. Brachytherapy may be an alternative method of additional targeted adjuvant radiotherapy with acceptable rates of toxicity.MethodsA retrospective chart review of all patients undergoing resection for metastatic brain lesions and permanent low-dose rate Cs-131 brachytherapy was performed for one institution over a 10-year period. All patients had previous radiation therapy already and, after surgery, were followed with imaging every three months. Patient demographics, disease characteristics, intracranial disease, peri- and post-operative complications, and outcomes were recorded. The primary outcome of interest was local tumor recurrence at the site of brachytherapy while secondary outcomes included distant disease progression (within the brain) and complications such as radiation necrosis.ResultsDuring the study period, nine cases of individual patients met inclusion criteria. The median preoperative lesion diameter was 3 cm (0.8–4.1). The median overall survival after surgery and brachytherapy was 10.3 months, after excluding two patients who were lost to follow-up. Six of nine patients had no local recurrence, while three patients had development or progression of distant lesions. No patients experienced acute or delayed complications.ConclusionCs-131 brachytherapy is a promising alternative method for controlling brain metastases after previous radiation interventions and surgical resection. In this case series, there were no incidences of local tumor recurrence or complications such as radiation necrosis.

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Iodine-125 brachytherapy as upfront and salvage treatment for brain metastases

Cited by 10 publications

References 27 publications

Brain volume reduction after whole-brain radiotherapy: quantification and prognostic relevance

Brain volume reduction after whole-brain radiotherapy: quantification and prognostic relevance

CyberKnife Radiosurgery in Recurrent Brain Metastases: Do the Benefits Outweigh the Risks?

Outcomes of Metastatic Brain Lesions Treated with Radioactive Cs-131 Seeds after Surgery: Experience from One Institution

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