Pineal region tumours treated with interstitial brachytherapy with low activity sources (192-iridium)

Abstract

Three patients with tumours of the pineal region underwent interstitial Ir-192 brachytherapy. Histological diagnoses were obtained in all patients, by stereotactic biopsy and included one germinoma, one mixed pineoblastoma/pineocytoma, and one astrocytoma grade III. Our approach to pineal region neoplasms is first to decide whether stereotactic biopsy or surgery should be performed. When a pineal lesion is thought to be benign on the basis of imaging, such as benign teratoma, surgery is performed to resect the entire lesion. When a definitive diagnosis is not possible, stereotactic biopsy is performed to obtain a histological diagnosis for treatment planning, using a Brown-Roberts-Wells (BRW) stereotactic apparatus with computed tomography (CT) or magnetic resonance imaging (MRI). When a lesion is malignant and localized, stereotactic implantation of catheters for interstitial brachytherapy is performed simultaneously. Radioactive Ir-192 seeds are inserted into the catheters and maintained for 5-10 days to give 36 Gy of irradiation at the tumour periphery. Sequential CT scans and MRI after treatment revealed tumour disappearance in two patients with germinoma and high grade astrocytoma and tumour reduction in the patient with mixed pineoblastoma/pineocytoma. No significant morbidity or mortality occurred in any of these patients after stereotactic biopsy and brachytherapy. The technique and the advantages of this therapeutic approach to selected pineal region tumours are described and discussed.

Outcome and prognostic features in adult pineoblastomas: analysis of cases from the SEER database

“…Furthermore, these patients are managed in different ways in different institutions complicating the interpretation of published literature. Adult PBL patients have been treated with localized radiotherapy to the pineal region [21,25,26,35] or subjected to radical resection, radiotherapy, and chemotherapy [3,31]. Previous series have been published without central histological review and diagnostic confirmation only undertaken by the pathologist at the initial institution to which the patient presented [1,11,16].…”

Pineal parenchymal tumor of intermediate differentiation:diagnostic pitfalls and discussion of treatment options of a rare tumor entity

“…PBs are also treated by surgical resection and/or radiotherapy; sometimes, also platinum-based chemotherapeutic agents are administered [5,17,21,29]. Radiation therapy is performed by either fractionated external beam radiation, gamma-knife radiosurgery, or brachytherapy [8,9,12,19,24]. The optimal adjuvant therapy protocols for each tumor entity, however, are still not defined.…”

Management of primary intracranial germinomas: diagnostic surgery or radical resection?

“…Despite the variation in adjuvant therapy, it is clear that radical resection of intracranial germinomas offered no benefit over biopsy. Because management strategies for intracranial germinomas are greatly dependent on accurate histological diagnosis of individual tumors, 1,3,23,28,29,37 the primary goal of surgery should be to obtain a sufficient volume of tumor tissue for histological examination.…”