Permanent High-Activity Iodine-125 in the Management of Petroclival Meningiomas: Case Reports

Kumar, Pradeep; Good, Roger R.; Patil, Angelo A.; Leibrock, Lyal G.

doi:10.1227/00006123-198909000-00019

Cited by 13 publications

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“…The results of Kumar et al [12][13][14][15][16] were impressive: all 15 patients were alive at the end of the follow-up at 8 to 92 months with no acute or late complications, and 11 tumours responded completely and the remaining 4 responded partially. Inspired by their results, we implanted permanent 1-125 seeds into parasellar and/or clival meningiomas in 25 patients and into globoid intracranial meningiomas of 19 elderly patients.…”

Section: Interstitial Radiotherapy Of 25 Parasellar-clival Meningiomasmentioning

confidence: 90%

“…1-125 seeds were implanted permanently in the target points through the needle. Implantation was performed in 7 parasellar tumours under direct CT control [13]: after a burr hole, the tumour was punctured in a CT scanner and the needle tip was checked for correct positioning before implantation.…”

Section: Implantationmentioning

confidence: 99%

“…Kumar et al [12][13][14][15][16] implanted 1-125 seeds permanently into 6 primary and 9 recurrent skull base meningiomas, in two cases at craniotomy and in the remaining 13 cases stereotactically under local anaesthesia. The tumour sites were: cerebellopontine angle (n = 7), sphenoid (n = 2), tuberculum sellae (n = 2), posterior clinoid (n = 1), optic nerve (n = 1), olfactory groove (n = 1), and clivus (n = 1).…”

Section: Interstitial Radiotherapy Of Meningiomasmentioning

confidence: 99%

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Interstitial radiotherapy of 25 parasellar/clival meningiomas and 19 meningiomas in the elderly

et al. 1996

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I-125 seeds were permanently implanted into 25 parasellar-clival meningiomas (median age of patients, 56 y) and 19 globoid meningiomas in the elderly (median age of patients, 77 y) using stereotactic technique and 3-D dose planning. Total dose at the tumour margin was increased during the series from 100 Gy to 150 Gy. The procedure caused no mortality and no serious bleeding, but injury to the III cranial nerve due to puncture occurred in one (4%) of the 25 parasellar-clival meningiomas. In two (4.5%) of the 44 cases the postoperative CT scan showed a misplaced seed, located at the tumour surface. Nonenhancing hypodense rings developed around the seeds ('hot spots') with a median diameter of 10.5 mm at 12 months corresponding to a median initial activity of 8.7 mCi. In general, meningiomas responded by slow reduction in volume. The parasellar-clival meningiomas were followed-up for a median of 19 months (6-32), and so far 4 tumours have shrunk moderately, 13 slightly, and 5 not at all. Pre-operative III, V or VI cranial nerve signs were present in 17 patients and subsided in 8 of them. On the other hand, facial numbness developed or increased in 9 of the 25 patients, indicating that the V nerve is rather sensitive to this type of irradiation. In the 19 meningiomas of the elderly, the median follow-up time was 14 months (5-26). The median relative tumour volume was 46% at 12 months. Accounting for tumour-related deaths only, the actuarial survival rate was 78% at 12 months and 62% at 24 months. In general, brain oedema persisted despite reduction in tumour volume. Stereotactic implantation of I-125 seeds into intracranial meningiomas is relatively safe. Interstitial radiotherapy represents a potential tool in the control of medium-sized intracranial meningiomas with minimal brain oedema, but its long-term impact and untoward effects remain to be followed-up.

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Section: Interstitial Radiotherapy Of 25 Parasellar-clival Meningiomasmentioning

confidence: 90%

Section: Implantationmentioning

confidence: 99%

Section: Interstitial Radiotherapy Of Meningiomasmentioning

confidence: 99%

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Interstitial radiotherapy of 25 parasellar/clival meningiomas and 19 meningiomas in the elderly

et al. 1996

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“…For such difficult cases, permanent iodine-125 seeds implanted using frame stereotaxy has been reported as an acceptable alternative [1,[14][15][16]. It can also serve as an adjunct to microsurgery.…”

Section: Discussionmentioning

confidence: 99%

“…When the tumor is resected, the compressed adjacent neural tissues are instantly relieved [13]. There are some cases, however, where surgery is not the treatment of choice: instances may arise where a patient may have multiple medical problems that may prohibit conventional surgery [1,[14][15][16]. The location of the tumor may make surgical resection difficult, as in cases where tumors invade the adjacent cavernous sinus or extend into the hypothalamus or adhere to internal carotid arteries and optic nerves.…”

Section: Introductionmentioning

confidence: 99%

Brachytherapy for Intracranial Meningioma Using a Permanently Implanted Iodine-125 Seed

Obasi

Barnett²,

Suh

2002

Stereotact Funct Neurosurg

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Purpose: To investigate the response and complications of iodine-125 brachytherapy for the treatment of recurrent and newly diagnosed meningiomas. Clinical cases of 2 patients treated with this method are presented. Materials and Methods: Thirteen patients with primary and recurrent intracranial meningioma were treated by frameless stereotactic implantation of iodine-125 seeds from January 1996 to June 1998. The total dose to decay ranged from 7,000 to 17,000 cGy, with a dose rate of 5–10 cGy/h. Results: All 11 evaluable patients had a decrease or stabilization in the size of their lesions as detected by MRI during follow-up. There were no acute complications. All patients who received a total dose greater than 10,000 cGy had postoperative radiation necrosis and/or vasogenic edema while only 20% of the patients who received doses of 10,000 cGy or less had radiation changes (p = 0.002). Conclusions: MRI-guided stereotactically assisted permanent implantation of iodine-125 seeds seems to be a safe, effective and noncomplicated method for the treatment of primary and recurrent meningiomas for selected patients, when doses are limited to 10,000 cGy.

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Role of brachytherapy in the management of the skull base meningioma treatment of skull base meningiomas

Kumar

Patil

Syh

et al. 1993

Cancer

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Background. The treatment of primary and recurrent skull base meningiomas presents a formidable surgical problem. Methods. Fifteen patients with primary and recurrent skull base meningiomas were treated by means of interstitial irradiation with iodine 125 (125I) seed implantation. The physical characteristics of 125I enabled the authors to administer a minimum tumor dose ranging from 100 to 500 Gy at a low dose rate of 0.05–0.25 Gy per hour. Results. All 15 patients are alive at a median follow‐up of 29 months. Of the 15 patients, 2 with calcification and 2 without calcification achieved only partial responses. The remaining 11 patients achieved a complete response. No early or late complications were observed. Conclusions. From these data, the authors conclude that interstitial irradiation with 125I seeds is an effective, safe, and simple method in the treatment of both recurrent and primary skull base meningiomas.

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Permanent High-Activity Iodine-125 in the Management of Petroclival Meningiomas: Case Reports

Abstract: Two cases of petroclival meningiomas are reported wherein the tumors were completely destroyed without surgical resection or external-beam irradiation by means of permanent stereotactic implantation of one or two high-activity iodine-125 seeds.

Cited by 13 publications

References 0 publications

Interstitial radiotherapy of 25 parasellar/clival meningiomas and 19 meningiomas in the elderly

Interstitial radiotherapy of 25 parasellar/clival meningiomas and 19 meningiomas in the elderly

Brachytherapy for Intracranial Meningioma Using a Permanently Implanted Iodine-125 Seed

Role of brachytherapy in the management of the skull base meningioma treatment of skull base meningiomas

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