Radiation necrosis after a combination of external beam radiotherapy and iodine-125 brachytherapy in gliomas

Hadi, Ibnu; Reitz, D.; Bodensohn, Raphael; Roengvoraphoj, Olarn; Niyazi, Maximilian; Tonn, Jörg‐Christian; Belka, Claus; Thon, Niklas; Nachbichler, Silke Birgit

doi:10.1186/s13014-021-01762-0

Cited by 3 publications

(4 citation statements)

References 36 publications

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“…Radiation necrosis was diagnosed using stereotactic biopsy and/or metabolic imaging in 8/75 patients (10.6%). The 1-and 2-year risk of necrosis was 5.1% and 11.7%, respectively, and was mainly determined by the treatment volume rather than by the interval between therapies [91].…”

Section: The Other Side Of the Coinmentioning

confidence: 96%

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Radiotherapy of High-Grade Gliomas: First Half of 2021 Update with Special Reference to Radiosensitization Studies

Fròsina

2021

IJMS

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Albeit the effort to develop targeted therapies for patients with high-grade gliomas (WHO grades III and IV) is evidenced by hundreds of current clinical trials, radiation remains one of the few effective therapeutic options for them. This review article analyzes the updates on the topic “radiotherapy of high-grade gliomas” during the period 1 January 2021–30 June 2021. The high number of articles retrieved in PubMed using the search terms (“gliom* and radio*”) and manually selected for relevance indicates the feverish research currently ongoing on the subject. During the last semester, significant advances were provided in both the preclinical and clinical settings concerning the diagnosis and prognosis of high-grade gliomas, their radioresistance, and the inevitable side effects of their treatment with radiation. The novel information concerning tumor radiosensitization was of special interest in terms of therapeutic perspective and was discussed in detail.

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Section: The Other Side Of the Coinmentioning

confidence: 96%

“…Patients with HGG treated with low-activity temporary iodine-125 stereotactic brachytherapy who also had external beam RT were investigated for radiation necrosis side effects [91]. Radiation necrosis was diagnosed using stereotactic biopsy and/or metabolic imaging in 8/75 patients (10.6%).…”

Section: The Other Side Of the Coinmentioning

confidence: 99%

Radiotherapy of High-Grade Gliomas: First Half of 2021 Update with Special Reference to Radiosensitization Studies

Fròsina

2021

IJMS

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“…Brachytherapy has been explored in the past for the treatment of brain tumors with promising local control results [5][6][7][8]. While the success of multiple trials of brachytherapy with radioisotope seeds has been described, one factor that may limit the usage of brachytherapy in the management of brain metastases is the rate of radiation necrosis, which is associated with inconsistent radiation dose to the tumor bed [9,10].…”

Section: Introductionmentioning

confidence: 99%

Dosimetric Impact of Source Displacement in GammaTile Surgically Targeted Radiation Therapy for Gliomas

Ng¹,

Yue²,

Shiue³

et al. 2023

Cureus

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BackgroundThis study aims to evaluate dosimetric changes that happened during the first month after GammaTile surgically targeted radiation therapy (STaRT) for gliomas due to seed displacement caused by cavity shrinkage in brain brachytherapy. MethodologyIn this study, 10 glioma patients had 4-11 GammaTiles placed along the resection bed after maximal safe resection during craniotomy. Each GammaTile is composed of four Cs-131 seeds embedded in a biodegradable collagen sponge to minimize seed movement and maintain seed-to-cavity surface distance. The Cs-131 seed positions were identified using VariSeed on day one. On day 30, post-implant computed tomography (CT) images and dosimetry parameters were calculated. An iterative closest point (ICP) algorithm was used to compute rigid transformation between the day one and day 30 seed clouds. The seed displacement was calculated after registration. The volume receiving 100% of the prescription dose (V100), the dose received by 90% of the planning target volume (D90_PTV), the planning target volume receiving 100% of the prescription dose (V100_PTV), and the dose to organs at risk (OARs) were calculated for both CT images to determine the dosimetric changes from any seed displacement. ResultsThe mean seed displacement of 1.8 ± 1.0 mm for all patients was observed between day one and day 30. The maximum seed displacement for each patient ranged from 2.3 mm to 7.3 mm. The mean V100 difference between day one and day 30 was 2.5 cc (range = 0.5-6.5 cc). The mean D90_PTVs were 95.5% (range = 69.0%-131.0%) and 98.1% (range = 19.9%-149.0%) on day one and day 30, respectively. The mean V100_PTVs were 88.4% (range = 81.3%-99.1%) and 87.9% (range = 47.0%-99.7%) on day one and day 30, respectively. On day one, the brainstem dose was 63.5 Gy for one case and 28.1 Gy for another case; while on day 30, the brainstem dose was 55.8 Gy and 20.6 Gy for the same patients, contributing to 7.7 Gy (12.8%) and 7.5 Gy (12.5%) dose reductions to brainstem for these patients, respectively. Only two patients received a dose to the optic nerves (34.1 Gy and 5.2 Gy). There were small changes (1.8 Gy and 0.5 Gy, respectively) in the dose to optic nerves when comparing the dose calculated on day one and the dose calculated on day 30 CT images. The same two patients received 30.4 Gy and 6.8 Gy to the chiasm, respectively. Small changes in the dose to the chiasm (≤1.1 Gy) were noted between day one and day 30. ConclusionsA maximum seed displacement of up to 7.3 mm and a mean seed displacement of 1.8 mm caused by cavity shrinkage were observed during the first month after GammaTile STaRT for gliomas. There were noticeable changes in dosimetry parameters. Changes in the doses to OARs, particularly the brainstem, were large (up to 12.8% of the prescription dose). These changes in dosimetry should be considered when evaluating treatment outcomes and planning future GammaTile treatments.

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“…Malignant brain tumor treatment commonly requires upfront or adjuvant irradiation, and brachytherapy has been attempted for these indications since the 1936 description of radon implantation, with subsequent evaluations of iodine-125(I-125), which carries a high risk of radiation necrosis due to higher delivered dose (150 Gy), and cesium-131(Cs-131), which is posited to have less such risk owing to lower dose deposition of 60 Gy; palladium-103(Pd103) is commonly used in prostate, ocular melanoma, and other applications but has not been described for brain tumors (Table 1). [2][3][4][5][6] The use of Cs-131 has been described for a variety of primary and metastatic brain tumor applications since its FDA approval in 2003. Wernicke et al implemented a seeds-on-a-strand formulation for resected brain tumors with median seed strength of 2.40U.…”

Section: Introductionmentioning

confidence: 99%

Patient‐specific radiological protection precautions following Cs collagen embedded Cs‐131 implantation in the brain

Prasad

Dauer

Chu

et al. 2022

J Applied Clin Med Phys

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Objective: Cesium-131 brachytherapy is an adjunct for brain tumor treatment, offering potential clinical and radiation protection advantages over other isotopes including iodine-125. We present evidence-based radiation safety recommendations from an initial experience with Cs-131 brachytherapy in the resection cavities of recurrent, previously irradiated brain metastases. Methods: Twenty-two recurrent brain metastases in 18 patients were resected and treated with permanent Cs-131 brachytherapy implantation using commercially procured seed-impregnated collagen tiles (GammaTile, GT Medical Technologies). Exposure to intraoperative staff was monitored with NVLAPaccredited ring dosimeters.For patient release considerations,NCRP guidelines were used to develop an algorithm for modeling lifetime exposure to family and ancillary staff caring for patients based on measured dose rates. Results: A median of 16 Cs-131 seeds were implanted (range 6-46) with median cumulative strength of 58. 72U (20.64-150.42). Resulting dose rates were 1.19 mSv/h (0.28-3.3) on contact, 0.08 mSv/h (0.01-0.35) at 30 cm, and 0.01 mSv/h (0.001-0.03) at 100 cm from the patient. Modeled total caregiver exposure was 0.91 mSv (0.16-3.26), and occupational exposure was 0.06 mSv (0.02-0.23) accounting for patient self -shielding via skull and soft tissue attenuation. Real-time dose rate measurements were grouped into brackets to provide close contact precautions for caregivers ranging from 1-3 weeks for adults and longer for pregnant women and children, including cases with multiple implantations. Conclusions: Radiological protection precautions were developed based on patient-specific emissions and accounted for multiple implantations of Cs-131, to maintain exposure to staff and the public in accordance with relevant regulatory dose constraints.

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Radiation necrosis after a combination of external beam radiotherapy and iodine-125 brachytherapy in gliomas

Cited by 3 publications

References 36 publications

Radiotherapy of High-Grade Gliomas: First Half of 2021 Update with Special Reference to Radiosensitization Studies

Radiotherapy of High-Grade Gliomas: First Half of 2021 Update with Special Reference to Radiosensitization Studies

Dosimetric Impact of Source Displacement in GammaTile Surgically Targeted Radiation Therapy for Gliomas

Patient‐specific radiological protection precautions following Cs collagen embedded Cs‐131 implantation in the brain

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