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

Abstract

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.

First application of GammaTile cesium-131 brachytherapy with maximal safe resection of a glioma in a patient with limited scleroderma

“…The low-dose GammaTile delivered to the scalp and scar did not result in acute skin changes or wound healing impairment at the overlaying incision at 3-, 6-, and 12-month follow-up. GammaTile also dramatically decreased the dose to surrounding brain parenchyma, when compared with EBRT plans, possibly contributing to the lack of appreciable radionecrosis radiographically through 12 months, as observed in other reports [16]. These findings also strengthen the dosimetric advantages of 131 Cs over previously utilized iodine-125 ( 125 I) [17][18][19], leading to a decrease in observed radionecrosis with 131 Cs and 125 I, 8.4% radiographic [20] vs. 23% symptomatic, respectively [21].…”

GammaTile: Comprehensive Review of a Novel Radioactive Intraoperative Seed-Loading Device for the Treatment of Brain Tumors

“…GammaTile therapy refers to the surgically targeted radiation therapy (STaRT) that provides instant, dose-intense treatment after resection [ 44 ]. Resection plus GammaTile therapy is instrumental in extending local recurrence-free survival with fewer complications, reduced patient burden, and guaranteed compliance [ 45 ]. Therefore, GammaTile therapy guarantees clinical efficiency, immediacy, and efficiency by enabling instant treatment at resection with reduced hospital stay [ 44 ].…”