Stereotactic Intracavitary Irradiation of Cystic Neoplasms of the Brain

Lunsford, L. Dade; Gumerman, Lewis W.; Levine, Geoffrey

doi:10.1159/000101118

Cited by 6 publications

(5 citation statements)

References 6 publications

(8 reference statements)

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“…Our results confirm the data previously reported regarding the lasting 74 to 100% decrease in volume following high-energy beta irradiation of cystic craniopharyngiomas. [3,31,34,39,44] In our study the mean value of the decrease of OCV measured by CT was 75.1%. Of the 48 cysts irradiated and afterwards controlled, 61% showed more than an 80% decrease of the OCV, with complete disappearance in 23%.…”

Section: Discussionsupporting

confidence: 46%

Treatment of cystic craniopharyngiomas with yttrium-90 colloid solution.

Degnan

1997

FOC

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The authors analyzed long-term follow-up data to assess the value of intracavitary irradiation with stereotactically implanted beta-emitting radioisotope 90Y-silicate colloid for the treatment of craniopharyngiomas. Fifty-seven craniopharyngiomas in 42 patients were selected for retrospective analysis. The yttrium-90 was implanted intracavitally, using computerized tomography-guided and three-dimensional stereotactic treatment planning. The cumulative dose aimed at the inner surface of the cyst wall was 300 Gy. An average of 75% shrinkage of the initial cyst volume was observed. In 18 cases the reduction was more than 91%, and the cyst disappeared totally in 11 cases. A 50% decrease in cyst volume was usually apparent between the 2nd and 4th months. A 70% decrease in cyst volume was seen by the 5th and 6th months and an 80% reduction by the 7th and 8th months. Cysts that were unchanged remained so throughout the observation period. The time course of volume reduction could be expressed mathematically by the formula of 0.73 X e-0.62 X T + 0.27, where “e” is the basic number of natural logarithm and “T” is the time expressed in months. Mean survival duration after intracavitary irradiation was 9.4 years. The shrinkage of the cyst was a consequence of fibrosis of the wall, as seen on histopathological examination. The neuroophthalmological prognosis was favorable only when the optic disc was normal or nearly normal at the time of the treatment. In the presence of preexisting optic atrophy, visual deterioration proved to be irreversible. The long-term results support the view that intracavitary90Y-irradiation is a noninvasive and very effective method of treatment for craniopharyngioma cysts. Because of the 1.1 mm half-life decay of beta irradiation, it cannot influence the solid part of the tumor; therefore, the best result can be expected in solitary cysts.

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Section: Discussionsupporting

confidence: 46%

Treatment of cystic craniopharyngiomas with yttrium-90 colloid solution.

Degnan

1997

FOC

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“…In previous reports [5, 6, 16, 17], the dose delivered to target cyst was within the range of 90–300 Gy. In order to enhance the therapeutic efficiency, the radiation dose in our studies was increased to 400–500 Gy.…”

Section: Discussionmentioning

confidence: 93%

“…Since Leksell and Liden had firstly reported a minimally invasive management strategy of intracavitary irradiation with radioisotopes (brachytherapy) in 1952 [3], several radiotherapeutic modalities have been advocated for treating craniopharyngiomas [4–8], and phosphorus-32 colloid ([ 32 P]) has been considered as the optimal choice for treating cystic craniopharyngioma among the therapeutic radioactive isotopes in treating cystic brain tumor. However, previous studies demonstrated that the radiation dose (about 90–300 Gy) of [ 32 P] was not adequate for effective treatment [5, 6], and the follow-up period of [ 32 P] therapy did not exceed 12–23 years although it is not short [5, 8, 9]. Therefore, we suggested that increasing the radiation dose with multiple administration of [ 32 P] would be a more effective alternative to the past treatment.…”

Section: Introductionmentioning

confidence: 99%

Treatment of cystic craniopharyngioma with phosphorus-32 intracavitary irradiation

Zhao¹,

Deng²,

Liang³

et al. 2009

Childs Nerv Syst

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Purpose The aim of the study was to evaluate the effect of phosphorus-32 colloid ([32P]) intracavitary irradiation on the treatment of patients with cystic craniopharyngiomas. Methods Twenty patients with predominantly cystic craniopharyngiomas were admitted from 1981 to 2006. Eleven patients had [32P] intracavitary irradiation by stereotactic injection or Ommaya cyst instillation as the primary treatment, and the remaining nine had the same internal irradiation as an adjuvant treatment after tumor resection. A calculated irradiation dose of 400~500 Gy per once was delivered to the cyst wall. Conclusion The patients were followed up ranging from 36 to 336 months; no operative morbidity or mortality was found from [32P] intracavitary irradiation. Fourteen patients (70%) had tumor progression and required further two to four times intracavitary irradiation. All 20 cases achieved tumor shrinkage or stabilization with effective outcome 3–6 months after the last [32P] therapy. For patients with cystic craniopharyngioma, [32P] administration by stereo-tactic injection or Ommaya cyst instillation is a safe and helpful option, which could improve the life quality, prolong the life span, and enhance the survival rate of cystic craniopharyngioma patients.

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“…[63] reported cyst control in 90.6% of patients using this treatment modality, however, Lunsford et al . [44] reported the ineffectiveness of intracavitary radiation for treating CPs with a more solid component. Installation of bleomycin into the cyst cavity has been advocated by Savas[69] and Takahashi[77] as an alternative, using its antineoplastic properties that interfere with DNA production, to suppress cyst fluid, and obliterate the cyst cavity.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive management of adult craniopharyngiomas: An analysis of our series and review of literature

Rahmathulla

Barnett

2013

Surg Neurol Int

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Background:Craniopharyngiomas (CPs) are slow growing tumors with an incidence of between 1.2% and 4.6%, having a bimodal age distribution typically peaking in childhood and in adults between 45 and 60 years. Recurrences occur even after documented gross total resections necessitating a combination of therapeutic strategies. Obtaining a cure of this tumor in adults without producing major side effects continues to remain elusive.Methods:We describe our results in 11 patients with CP treated in a minimally invasive fashion using a combination of techniques like burr hole aspiration, Ommaya reservoir placement, ventriculo-peritoneal (VP) shunting and focal radiation (Gamma Knife stereotactic radiosurgery/Intensity modulated radiotherapy [GKRS/IMRT]).Results:Visual function remained intact in all patients; endocrine status remained stable with two patients developing new postoperative diabetes insipidus. There was no periprocedural morbidity or mortality, with hospital stays for any in-patient procedure being 48 hours or less.Conclusions:Minimally invasive techniques such as cyst aspiration, insertion of a catheter with Ommaya reservoir, when combined with stereotactic radiosurgery/IMRT is an effective and safe option for management and long-term control of adult CPs. We believe the Ommaya catheter by itself could act as a stent, creating a tract allowing gradual drainage of cyst fluid and stabilization without necessitating any further interventions in selected cases.

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Stereotactic Intracavitary Irradiation of Cystic Neoplasms of the Brain

Cited by 6 publications

References 6 publications

Treatment of cystic craniopharyngiomas with yttrium-90 colloid solution.

Treatment of cystic craniopharyngiomas with yttrium-90 colloid solution.

Treatment of cystic craniopharyngioma with phosphorus-32 intracavitary irradiation

Minimally invasive management of adult craniopharyngiomas: An analysis of our series and review of literature

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