Neurocognitive function and quality of life in patients with newly diagnosed brain metastasis after treatment with intra-operative cesium-131 brachytherapy: a prospective trial

Pham, Anthony; Yondorf, M.; Parashar, Bhupesh; Scheff, Ronald; Pannullo, Susan C.; Ramakrishna, Rohan; Stieg, Philip E.; Schwartz, Theodore H.; Wernicke, A. Gabriella

doi:10.1007/s11060-015-2009-5

Cited by 28 publications

(25 citation statements)

References 39 publications

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“…Early postresection initiation of radiation-when residual tumor burden is minimal-could evince a relatively higher therapeutic ratio in rapidly proliferating tumors. 6,15 BT using a low-energy (i.e., short-range) isotope exposes less normal tissue to radiation than EBRT techniques, 31,34 and it may limit neurocognitive deficits 28,33 while allowing a higher local radiation dose. 34 Radiation source placement under intraoperative visualization also should allow a more precise identification of the area at risk than the postoperative imaging utilized for EBRT treatment.…”

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confidence: 99%

Resection and permanent intracranial brachytherapy using modular, biocompatible cesium-131 implants: results in 20 recurrent, previously irradiated meningiomas

Brachman

Youssef

Dardis

et al. 2019

Journal of Neurosurgery

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OBJECTIVEEffective treatments for recurrent, previously irradiated intracranial meningiomas are limited, and resection alone is not usually curative. Thus, the authors studied the combination of maximum safe resection and adjuvant radiation using permanent intracranial brachytherapy (R+BT) in patients with recurrent, previously irradiated aggressive meningiomas.METHODSPatients with recurrent, previously irradiated meningiomas were treated between June 2013 and October 2016 in a prospective single-arm trial of R+BT. Cesium-131 (Cs-131) radiation sources were embedded in modular collagen carriers positioned in the operative bed on completion of resection. The Cox proportional hazards model with this treatment as a predictive term was used to model its effect on time to local tumor progression.RESULTSNineteen patients (median age 64.5 years, range 50–78 years) with 20 recurrent, previously irradiated tumors were treated. The WHO grade at R+BT was I in 4 (20%), II in 14 (70%), and III in 2 (10%) cases. The median number of prior same-site radiation courses and same-site surgeries were 1 (range 1–3) and 2 (range 1–4), respectively; the median preoperative tumor volume was 11.3 cm3 (range 0.9–92.0 cm3). The median radiation dose from BT was 63 Gy (range 54–80 Gy). At a median radiographic follow-up of 15.4 months (range 0.03–47.5 months), local failure (within 1.5 cm of the implant bed) occurred in 2 cases (10%). The median treatment-site time to progression after R+BT has not been reached; that after the most recent prior therapy was 18.3 months (range 3.9–321.9 months; HR 0.17, p = 0.02, log-rank test). The median overall survival after R+BT was 26 months, with 9 patient deaths (47% of patients). Treatment was well tolerated; 2 patients required surgery for complications, and 2 experienced radiation necrosis, which was managed medically.CONCLUSIONSR+BT utilizing Cs-131 sources in modular carriers represents a potentially safe and effective treatment option for recurrent, previously irradiated aggressive meningiomas.

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confidence: 99%

Resection and permanent intracranial brachytherapy using modular, biocompatible cesium-131 implants: results in 20 recurrent, previously irradiated meningiomas

Brachman

Youssef

Dardis

et al. 2019

Journal of Neurosurgery

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“…We found that there was a statistical improvement in overall FACT-Br score at 4 and 6 months of follow-up when compared to baseline (162 vs. 143, p = 0.004; 164 vs. 143, p = 0.005, respectively), with an insignificant trend towards improvement at 2 and 12 months (154 vs. 143, p = 0.067; 159 vs. 149, p = 0.4, respectively). MMSE score was statistically improved at 4 months and up to 12 months compared to pre-treatment MMSE (30 vs. 29, p = 0.017; 30 vs. 29, p = 0.001, respectively) [21]. …”

Section: Discussionmentioning

confidence: 99%

Placement of 131 Cs permanent brachytherapy seeds in a large combined cavity of two resected brain metastases in one setting: case report and technical note

Greenwald

Taube

Yondorf

et al. 2019

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Large brain metastases are presently treated with surgical resection and adjuvant radiotherapy. However, local control (LC) for large tumors decreases from over 90% to as low as 40% as the tumor/cavity increases. Intraoperative brachytherapy is one of the focal radiotherapy techniques, which offers a convenient option of starting radiation therapy immediately after resection of the tumor and shows at least an equivalent LC to external techniques. Our center has pioneered this treatment with a novel FDA-cleared cesium-131 (131Cs) radioisotope for the resected brain metastases, and published promising results of our prospective trial showing superior results from 131Cs application to the large tumors (90%). We report a 57-year-old male patient, with metastatic hypopharyngeal brain cancer. The patient presented with two metastases in the right frontal and right parietal lobes. Post-resection of these lesions resulted in a large total combined cavity diameter of 5.3 cm, which was implanted with 131Cs seeds. The patient tolerated the procedure well, with 100% local control and 0% radiation necrosis. This case is unique in demonstrating that the 131Cs isotope was not only a convenient option of treating two resected brain metastases in one setting, but also that this treatment option offered excellent long-term LC and minimal toxicity rates.

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“…However, in general, local control refers to restriction of disease to the area immediately surrounding the resection cavity, while distant recurrence defines disease recurring or progressing outside the immediate area of the resection cavity. A notable exception included studies by Wernicke et al and Pham et al who reported 100% rate of local control, but some instances of regional recurrence defined as dural-based enhancement were > 5 mm from the resection cavity [10,11,12,13]. Summative assessments of treatment efficacy and toxicity were completed based on radioisotopes and brachytherapy techniques used in various studies.…”

Section: Methodsmentioning

confidence: 99%

“…Most studies on 131 Cs brachytherapy for treatment of brain metastases have been performed by Wernicke and colleagues including 24 patients in two studies and 42 in another research. Patients were treated with local resection, followed by implantation of permanent 131 Cs seeds (Table 2) [10,11,12,13]. These studies reported 100% of local brain control, low rates of regional recurrence, and distant progression within the brain, with no cases of radiation necrosis and minimal post-operative complications (Tables 4 and 6).…”

Section: Cesium-131mentioning

confidence: 99%

“…Since then, 125 I became the most frequently used brachytherapy isotope in the treatment of brain tumors, with the first treatment of brain metastases using brachytherapy in 1979 by Prados and colleagues [7]. Subsequently, other studies have been done evaluating the use of intraoperative photon radiation (photon radiosurgery -PRS) as well as other isotopes such as 131 Cs [8,9,10,11,12,13]. In particular, 131 Cs is a promising new isotope for the use in brachytherapy explored by Wernicke and colleagues in a series of studies on local resection followed by implantation of 131 Cs seeds in patients with brain metastases [10,11,12,13].…”

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The role of brachytherapy in the management of brain metastases: a systematic review

2020

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Purpose: Brain metastases have a highly variable prognosis depending on the primary tumor and associated prognostic factors. Standard of care for patients with these tumors includes craniotomy, stereotactic radiosurgery (SRS), or whole brain radiotherapy (WBRT) for patients with brain metastases. Brachytherapy shows great promise as a therapy for brain metastases, but its role has not been sufficiently explored in the current literature. Material and methods: The PubMed, Cochrane, and Scopus databases were searched using a combination of search terms and synonyms for brachytherapy, brain neoplasms, and brain metastases, for articles published between January 1 st , 1990 and January 1 st , 2018. Of the 596 articles initially identified, 37 met the inclusion criteria, of which 14 were review articles, while the remaining 23 papers with detailing individual studies were fully analyzed. Results: Most data focused on 125 I and suggested that it offers rates of local control and overall survival comparable to standard of care modalities such as SRS. However, radiation necrosis and regional recurrence were often high with this isotope. Studies using photon radiosurgery modality of brachytherapy have also been completed, resulting superior regional control as compared to SRS, but worse local control and higher rates of radiation necrosis than 125 I. More recently, studies using the 131 Cs for brachytherapy offered similar local control and survival benefits to 125 I, with low rates of radiation necrosis. Conclusions: For a variety of reasons including absence of physician expertise in brachytherapy, lack of published data on treatment outcomes, and rates of radiation necrosis, brachytherapy is not presently a part of standard paradigm for brain metastases. However, our review indicates brachytherapy as a modality that offers excellent local control and quality of life, and suggested that its use should be further studied.

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Neurocognitive function and quality of life in patients with newly diagnosed brain metastasis after treatment with intra-operative cesium-131 brachytherapy: a prospective trial

Cited by 28 publications

References 39 publications

Resection and permanent intracranial brachytherapy using modular, biocompatible cesium-131 implants: results in 20 recurrent, previously irradiated meningiomas

Resection and permanent intracranial brachytherapy using modular, biocompatible cesium-131 implants: results in 20 recurrent, previously irradiated meningiomas

Placement of 131 Cs permanent brachytherapy seeds in a large combined cavity of two resected brain metastases in one setting: case report and technical note

The role of brachytherapy in the management of brain metastases: a systematic review

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