Long-term outcome of 89 low-grade brain-stem gliomas after interstitial radiation therapy

Abstract

Between 1974 and 1985, 89 patients suffering from histologically confirmed, nonresectable low-grade astrocytomas located in the brain stem were entered into a retrospective study. Iodine-125 (125I) was implanted in 29 patients and iridium-192 (192Ir) in 26 patients. Computerized tomography revealed that 78% of the tumors in these patients were located chiefly in the mesencephalic region, 70% were circumscribed, and 78% were contrast-enhanced. Thirty-four patients underwent biopsy without prior aggressive tumor-specific therapy such as chemotherapy or external beam irradiation. Among these, 70% of the tumors were located predominantly in the pons, 74% were diffuse, and 59% were hypodense or isodense after contrast enhancement. Long-term follow-up investigations indicated that life expectancy after interstitial radiation therapy with 125I implanted directly by catheter either permanently or temporarily showed a more favorable trend than that after treatment with 192Ir. Interstitial radiation therapy with 125I appears to be an effective treatment for slowly proliferating, differentiated, well-delineated, nonresectable brain-stem gliomas. This technique makes it possible to achieve radiosurgical tumor control and, when carefully applied, represents the least traumatic treatment. Reduction of the tumor mass brings about improvement of the clinical symptoms. Further investigations on the biological behavior of brain-stem gliomas and prospective randomized long-term follow-up studies are necessary to evaluate the different kinds of treatment available for these patients.

Brachytherapy

“…Possibly due to high energy emission and less rapid dose falloff, 192 Ir may cause side effects in the brain stem. 30 Although most authors use 125 I for brachytherapy in patients with supratentorial tumors, to our knowledge there are no reports indicating that radiation with 125 I leads to an increase or decrease in survival compared with 192 Ir in patients with high grade gliomas. The much higher dose rate and the referenced isodose beyond the outer margins of the tumor in the Amsterdam group may have contributed to the onset of a sudden palsy in some patients, resembling a vascular accident, 6 -12 months after brachytherapy.…”

Brachytherapy in treatment of brain tumors

“…Âîíè òàêîae â³äмîâëяюòü хâîðèм ó ïðîâåäåíí³ БТ зà íà-яâíîñò³ êë³í³чíèх ïðîяâ³â òà ïðîãðåñóâàííя ïóхëèíè зà äàíèмè íåéðîâ³зóàë³зóючèх мåòîä³â [11].…”

“…³äðîäaeåí-íя ³íòåðåñó äî БТ ПÃМ ó 70-80-ò³ ðîêè мèíóëîãî ñòîë³òòя ïîâ'язàíå з ðîзðîбêîю íîâèх ³зîòîï³â ³ âäîñêîíàëåííям ñòåðåîòàêñèчíî¿ òåхí³êè. Îòðèмàí³ ïîзèòèâí³ ðåзóëüòàòè ë³êóâàííя хâîðèх з ïðèâîäó ïåðâèííèх зëîяê³ñíèх ãë³îм â³äíîâèëè ³íòåðåñ äî öüîãî мåòîäó [9][10][11][12][13]. Пðîòå, äâ³ ïðîбëåмè îбмåaeó-âàëè шèðîêå âïðîâàäaeåííя БТ: âèñîêà чàñòîòà âèíèêíåííя ðàä³àö³éíîãî íåêðîзó, щî ïîòðåбóâàëî âèêîðèñòàííя ñòåðî¿ä³â мàéaeå â óñ³х хâîðèх, òà íåîбх³äí³ñòü ïîâòîðíîãî х³ðóðã³чíîãî âòðóчàííя мàéaeå ó 50% ïàö³єíò³â [10,14].…”

Stereotactic Brachytherapy for Brain Tumors

“…Considerable data exist for brachytherapeutic treatment of low-grade gliomas (WHO I pilocytic astrocytomas, WHO II astrocytomas, oligoastrocystomas and oligodendrogliomas), both in children and adults (Julow et al, 2007;Korinthenberg et al, 2010;Kreth et al, 1995;Mehrkens et al, 2004;Mundinger et al, 1991;Ostertag et al, 1993;Ruge et al, 2011a;Schatz et al, 1994;Suchorska et al, 2011).…”