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Niedermeyer S, Terpolilli NA, Nerlinger P, Weller J, Schmutzer-Sondergeld M, Quach S, Thon N. Efficacy and safety of cysto-ventricular catheter implantation for space-occupying cysts arising from glioma and brain metastasis: a retrospective study. Acta Neurochir (Wien) 2024; 166:36. [PMID: 38277007 PMCID: PMC10817835 DOI: 10.1007/s00701-024-05931-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Cysto-ventricular catheters (CVC) have emerged as promising treatment option for cystic craniopharyngioma and arachnoid cysts, but their effectiveness in treating cysts originating from glioma or brain metastasis (BM) remains limited. This study aimed to analyze the efficacy of CVC in patients with glioma and BM as well as procedure-associated morbidity. METHODS This single-center retrospective study included all patients treated with CVC placement for acquired space-occupying cysts deriving from previously treated glioma or BMs between 1/2010 and 12/2021. RESULTS A total of 57 patients with a median age of 47 years (IQR 38-63) were identified. Focal neurological deficits were the predominant symptoms in 60% of patients (n = 34), followed by cephalgia in 14% (n = 8), and epileptic seizures in 21.1% (n = 12). Accurate CVC placement was achieved in all but one case requiring revision surgery due to malposition. Three months after CVC implantation, 70% of patients showed symptomatic improvement. Multivariate logistic regression analysis identified the development of space-occupying cysts later in the course of the disease (OR 1.014; p = 0.04) and a higher reduction of cyst-volume postoperatively (OR 1.055; p = 0.05) were significant predictors of postoperative symptomatic improvement following CVC placement. Local cyst recurrence was observed in three cases during follow-up MRI after an average time of 5 months (range 3-9 months). Further complications included secondary malresorptive hydrocephalus in three cases and meningeosis neoplastica in one patient. CONCLUSIONS Stereotactic implantation of CVC is an efficient treatment option for patients suffering from symptomatic space-occupying cysts from BMs or glioma, independently from their CNS WHO grade. However, a vigilant approach is crucial regarding potential complications and treatment failures.
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Affiliation(s)
- Sebastian Niedermeyer
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Nicole A Terpolilli
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Pia Nerlinger
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Jonathan Weller
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Schmutzer-Sondergeld
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Meißner AK, Dreher L, Jünger ST, Visser-Vandewalle V, Ruge MI, Rueß D. Frame-based stereotactic implantation of cystoventricular shunts for treating acquired intracerebral cysts. J Neurosurg 2022; 137:227-234. [PMID: 34767526 DOI: 10.3171/2021.7.jns211180] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The treatment of symptomatic, progressive or recurrent acquired intracerebral cysts is challenging, especially when they are localized in eloquent structures. In addition to resection, endoscopic fenestration, or stereotactic puncture, the implantation of a cystoventricular shunt by stereotactic guidance (SCVS) has been reported as a minimally invasive procedure; however, only scarce data are available regarding its feasibility and efficacy. Here, the authors evaluated the feasibility and efficacy of frame-based SCVS in patients with acquired intracranial cysts. METHODS In this single-center retrospective analysis, the authors included all patients with acquired intracerebral cysts treated by SCVS following a standardized prospective protocol between 2012 and 2020. They analyzed clinical symptoms, complications, and radiological outcome with regard to cyst volume reduction by 3D volumetry. RESULTS Thirty-four patients (17 females and 17 males; median age 44 years, range 5-77 years) were identified. The median initial cyst volume was 11.5 cm3 (range 1.6-71.6 cm3), and the mean follow-up was 20 months (range 1-82 months). At the last follow-up, 27 of 34 patients (79%) showed a cyst volume reduction of more than 50%. Initial symptoms improved or resolved in 74% (n = 25) and remained stable in 24% (n = 8). No permanent clinical deterioration after treatment was observed. The total complication rate was 5.9%, comprising transient neurological deterioration (n = 1) and ventriculitis (n = 1). There were no deaths. The overall recurrence rate was 11.8%. CONCLUSIONS In this study, SCVS proved to be a safe, minimally invasive, and effective treatment with reliable long-term volume reduction, resulting in clinical improvement and a minor complication rate.
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Affiliation(s)
- Anna-Katharina Meißner
- 1Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Lena Dreher
- 1Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Stephanie Theresa Jünger
- 1Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Veerle Visser-Vandewalle
- 2Department of Stereotactic and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne; and
| | - Maximilian I Ruge
- 2Department of Stereotactic and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne; and
- 3Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Germany
| | - Daniel Rueß
- 2Department of Stereotactic and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne; and
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Effect of neoadjuvant iodine-125 brachytherapy upon resection of glioma. BMC Cancer 2022; 22:397. [PMID: 35413858 PMCID: PMC9004181 DOI: 10.1186/s12885-022-09504-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background A more extensive surgical resection of glioma contributes to improved overall survival (OS) and progression-free survival (PFS). However, some patients miss the chance of surgical resection when the tumor involves critical structures. Purpose The present study aimed to assess the feasibility of neoadjuvant 125I brachytherapy followed by total gross resection for initially inoperable glioma. Methods Six patients diagnosed with inoperable glioma due to invasion of eloquent areas, bihemispheric diffusion, or large tumor volume received 125I brachytherapy. Surgical resection was performed when the tumor shrank, allowing a safe resection, assessed by the neurosurgeons. Patients were followed up after surgery. Results Shrinkage of the tumor after adjuvant 125I brachytherapy enabled a total gross resection of all six patients. Four patients were still alive at the last follow-up, with the longest survival time of more than 50 months, two of which returned to everyday life with a KPS of 100. Another two patients had neurological injuries with KPSs of 80 and 50, respectively. One patient with grade II glioma died 34 months, and another with grade IV glioma died 40 months after the combined therapy. Conclusions In the present study, the results demonstrated that 125I brachytherapy enabled a complete resection of patients with initially unresectable gliomas. 125I brachytherapy may offer a proper neoadjuvant therapy method for glioma.
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Pinnaduwage DS, Srivastava SP, Yan X, Jani S, Brachman DG, Sorensen SP. Dosimetric Impacts of Source Migration, Radioisotope Type, and Decay with Permanent Implantable Collagen Tile Brachytherapy for Brain Tumors. Technol Cancer Res Treat 2022; 21:15330338221106852. [PMID: 35712977 PMCID: PMC9210077 DOI: 10.1177/15330338221106852] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Brachytherapy using permanently implantable collagen tiles containing cesium-131 (Cs-131) is indicated for treatment of malignant intracranial neoplasms. We quantified Cs-131 source migration and modeled the resulting dosimetric impact for Cs-131, iodine-125 (I-125), and palladium-103 (Pd-103). Methods and Materials: This was a retrospective analysis of a subgroup of patients enrolled in a prospective, single-center, nonrandomized, clinical trial (NCT03088579) of Cs-131 collagen tile brachytherapy. Postimplant Cs-131 plans and hypothetical I-125 and Pd-103 calculations were compared for 20 glioblastoma patients for a set seed geometry. Dosimetric impact of decay and seed migration was calculated for 2 hypothetical scenarios: Scenario 1, assuming seed positions on a given image set were unchanged until acquisition of the subsequent set; Scenario 2, assuming any change in seed positions occurred the day following acquisition of the prior images. Seed migration over time was quantified for a subset of 7 patients who underwent subsequent image-guided radiotherapy. Results: Mean seed migration was 1.7 mm (range: 0.7-3.1); maximum seed migration was 4.3 mm. Mean dose to the 60 Gy volume differed by 0.4 Gy (0.6%, range 0.1-1.0) and 0.9 Gy (1.5%, range 0.2-1.7) for Cs-131, 1.2 Gy (2.0%, range 0.1-2.1) and 1.6 Gy (2.6%, range 1.2-2.6) for I-125, and 0.8 Gy (1.3%, range 0.2-1.5) and 1.4 Gy (2.3%, range 0.3-1.9) for Pd-103, for Scenarios 1 and 2, respectively, compared with the postimplant plan. For a set seed geometry mean implant dose was higher for Pd-103 (1.3 times) and I-125 (1.1 times) versus Cs-131. Dose fall-off was steepest for Pd-103: gradient index 1.88 versus 2.23 (I-125) and 2.40 (Cs-131). Conclusions: Dose differences due to source migration were relatively small, suggesting robust prevention of seed migration from Cs-131-containing collagen tiles. Intratarget heterogeneity was greater with Pd-103 and I-125 than Cs-131. Dose fall-off was fastest with Pd-103 followed by I-125 and then Cs-131.
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Affiliation(s)
- Dilini S. Pinnaduwage
- Department of Radiation Oncology, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Shiv P. Srivastava
- Department of Radiation Oncology, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Xiangsheng Yan
- Department of Radiation Oncology, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Shyam Jani
- Department of Radiation Oncology, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - David G. Brachman
- Department of Radiation Oncology, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
- GT Medical Technologies, Tempe, AZ, USA
| | - Stephen P. Sorensen
- Department of Radiation Oncology, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
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Roshchina KE, Bekyashev AK, Gasparyan TG, Aleshin VA, Osinov IK, Savateev AN, Khalafyan DA. Modern possibilities of neurosurgical treatment of brain metastases. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:119-125. [PMID: 36252202 DOI: 10.17116/neiro202286051119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Despite significant progress in neuroimaging and introduction of new combined treatments for solid tumors, brain metastases are still adverse factor for overall survival. Brain metastases are diagnosed in 8-10% of patients and associated with extremely poor prognosis. These lesions result focal and general cerebral symptoms. Literature review highlights the current principles of surgical treatment of metastatic brain lesions in patients with solid tumors.
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Affiliation(s)
- K E Roshchina
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - A Kh Bekyashev
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - T G Gasparyan
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
- Scientific Center of Neurology, Moscow, Russia
| | - V A Aleshin
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - I K Osinov
- Burdenko Neurosurgical Center, Moscow, Russia
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Li F, Wang L, Zhang Y, Feng W, Ju T, Liu Z, Wang Z, Du X. A Retrospective Study on Using a Novel Single Needle Cone Puncture Approach for the Iodine-125 Seed Brachytherapy in Treating Patients With Thoracic Malignancy. Front Oncol 2021; 11:640131. [PMID: 34136382 PMCID: PMC8200774 DOI: 10.3389/fonc.2021.640131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/06/2021] [Indexed: 12/21/2022] Open
Abstract
Background Patients with progressive thoracic malignancy characterized by large irregular tumors with necrosis and life-threatening symptoms lack effective treatments. We set out to develop a single needle cone puncture method for the Iodine-125 seed (SNCP-125I) brachytherapy, and aim to report the initial results. Methods 294 patients with advanced thoracic malignancy were treated with local SNCP-125I brachytherapy between March 2009 and July 2020, followed by thorough evaluation of clinical outcome, overall survival (OS), progression-free survival (PFS) and procedure-related complications after treatment. Results The overall response rate (ORR) among the treated patients was 81.0% (238/294). Life-threatening symptoms due to tumor oppression, hemoptysis and large irregular tumor with necrosis were successfully alleviated after the SNCP-125I treatment with a remission rate at 91% to 94%. The median OS and PFS were 13.6 months and 5.8 months, respectively. Procedure-related side effects including pneumothorax (32/294), blood-stained sputum (8/294), subcutaneous emphysema (10/294), puncture site bleeding (16/294) and chest pain (6/294) were observed. Patients who were able to follow with chemotherapy or immunotherapy experienced extended OS and PFS, as compared with patients who opted to receive hospice care (16.5 months Vs. 11.2 months). Further pathological and immunological analysis showed that SNCP-125I induced tumor lymphocytes infiltration and long-term tumor necrosis. Conclusion SNCP-125I brachytherapy effectively eliminates life-threatening symptoms due to local tumor oppression, hemoptysis and large irregular and necrotic tumors in patients with unresectable chest malignancy and significantly induces local tumor regression. SNCP-125I brachytherapy combines with chemotherapy significantly prolong OS and PFS compare with SNCP-125I brachytherapy alone.
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Affiliation(s)
- Fenge Li
- Department of Oncology, Tianjin Beichen Hospital, Tianjin, China.,Department of Melanoma Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Liping Wang
- Department of Oncology, Weifang People's Hospital, Weifang, China
| | - Yixiang Zhang
- Pulmonary Medicine, Weifang People's Hospital, Weifang, China
| | - Weihong Feng
- Department of Oncology, Tianjin Beichen Hospital, Tianjin, China
| | - Tao Ju
- Department of Oncology, Tianjin Beichen Hospital, Tianjin, China
| | - Zaiping Liu
- Department of Pathology and Laboratory Medicine, IWK Women's and Children's Health Center, Halifax, NS, Canada
| | - Zhenglu Wang
- Pathology Department, Tianjin First Central Hospital, Tianjin, China
| | - Xueming Du
- Department of Oncology, Tianjin Beichen Hospital, Tianjin, China
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Wang C, Xu Z, Wang S, Peng L, Zhang W, Li X, Yang L, Luan Y, Su T, Li Z, Hu X. Clinical importance of ADC in the prediction of 125I in the treatment for gliomas. J Cancer 2021; 12:1945-1951. [PMID: 33753992 PMCID: PMC7974523 DOI: 10.7150/jca.50789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/26/2020] [Indexed: 01/15/2023] Open
Abstract
Objectives: To determine whether the minimum apparent diffusion coefficient (minADC) value can stratify survival in patients with glioma before 125I brachytherapy. Methods: The study was approved by the Institutional Review Board, and the requirement for informed consent was waived. Twenty-three patients (16 male, 7 female; median age, 48 years) with high-grade glioma (HGG) (n=9) or recurrence after multimodal treatment (n=14) were included in this study. minADC values were obtained before 125I implantation. Overall survival (OS) and progression-free survival (PFS) were analyzed with Cox proportional hazards regression models and the Kaplan-Meier method with the log-rank test. Results: For 125I-treated patients, the hazard ratio for OS in patients with ADC≥1.0*10^-3 mm2·sec-1 (high minADC) versus ADC<1.0*10^-3 mm2·sec-1 (low minADC) was 0.220 (95% confidence interval: 0.066, 0.735). The median OS was 12 months for patients with high minADC values and 6.0 months for those with low minADC values, and the differences were significant (p=0.032). The median PFS was 12 months for patients with high minADC values and 4 months for those with low minADC values. Significant differences were found in the long-rank test (p=0.013). The multivariate analysis results showed that minADC pre-125I implantation was an independent predictor of OS and PFS in patients receiving 125I brachytherapy. Conclusions: Pre-125I implantation ADC analysis can stratify prognosis in 125I-treated patients with glioma, which may aid in choosing a suitable therapy for glioma patients.
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Affiliation(s)
- Congxiao Wang
- Department of the Interventional Medical Center, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Zhijian Xu
- JinHua Municipal Central Hospital, JinHua, 321000, Zhejiang, China
| | - Song Wang
- Department of the Interventional Medical Center, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Lijing Peng
- Department of Clinical Laboratory, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Wei Zhang
- Department of the Interventional Medical Center, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Xueda Li
- Department of the Interventional Medical Center, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Lili Yang
- Department of the Interventional Medical Center, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Ying Luan
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, China
| | - Tao Su
- Department of the Interventional Medical Center, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Zixiang Li
- Department of the Interventional Medical Center, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Xiaokun Hu
- Department of the Interventional Medical Center, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
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Permanent iodine-125 brachytherapy for patients with progressive or recurrent high-grade gliomas. BMC Cancer 2020; 20:591. [PMID: 32580723 PMCID: PMC7315528 DOI: 10.1186/s12885-020-07086-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/17/2020] [Indexed: 01/11/2023] Open
Abstract
Background The prognosis of patients with progressive or recurrent high-grade gliomas (HGGs) after surgery remains poor. Iodine-125 brachytherapy is emerging as a salvage method for the treatment of gliomas. This study aimed to investigate whether permanent iodine-125 brachytherapy could be used as an effective therapeutic method even without radiotherapy and/or chemotherapy for progressive or recurrent HGG after gross total resection. Methods Between March 2004 and August 2016, 58 patients with progressive or recurrent HGG after gross total resection were included in this study. Twenty-nine patients underwent radiotherapy and/or chemotherapy and then permanent iodine-125 brachytherapy (SRCI group). Twenty-nine patients underwent permanent iodine-125 brachytherapy alone (SI group). Follow-up was carried out at 1, 3, and 6 months and then at 1, 2, 3, and 5 years after iodine-125 implantation. The median overall survival (OS) and progression-free survival (PFS), procedure-related complications and clinical outcomes were evaluated. Results No procedure-related fatal events happened. The temporary morbidity rate was 11.9%. The median OS and PFS for patients in the SI group were 22 and 8 months compared with 21 and 7 months in the SRCI group. No significant differences were found. Age and Karnofsky Performance Status (KPS) were independent prognostic factors for OS. Age, KPS and histology were independent prognostic factors for PFS. Conclusions Permanent iodine-125 brachytherapy could be used as an effective therapeutic method even without radiotherapy and/or chemotherapy for progressive or recurrent HGG after gross total resection.
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He X, Liu M, Zhang M, Sequeiros RB, Xu Y, Wang L, Liu C, Wang Q, Zhang K, Li C. A novel three-dimensional template combined with MR-guided 125I brachytherapy for recurrent glioblastoma. Radiat Oncol 2020; 15:146. [PMID: 32513276 PMCID: PMC7282063 DOI: 10.1186/s13014-020-01586-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background At present, the treatment of recurrent glioblastoma is extremely challenging. In this study, we used a novel three-dimensional non-coplanar template (3DNPT) combined with open MR to guide 125I seed implantation for recurrent glioblastoma. The aim of this study was to evaluate the feasibility, accuracy, and effectiveness of this technique. Methods Twenty-four patients of recurrent glioblastoma underwent 3DNPT with open MR-guided 125I brachytherapy from August 2017 to January 2019. Preoperative treatment plan and 3DNPT were made according to enhanced isovoxel T1-weighted MR images. 125I seeds were implanted using 3DNPT and 1.0-T open MR imaging guidance. Dosimetry verification was performed after brachytherapy based on postoperative CT/MR fusion images. Preoperative and postoperative dosimetry parameters of D90, V100, V200, conformity index (CI), external index (EI) were compared. The objective response rate (ORR) at 6 months and 1-year survival rate were calculated. Median overall survival (OS) measured from the date of brachytherapy was estimated by Kaplan-Meier method. Results There were no significant differences between preoperative and postoperative dosimetry parameters of D90, V100, V200, CI, EI (P > 0.05). The ORR at 6 months was 75.0%. The 1-year survival rate was 58.3%. Median OS was 12.9 months. One case of small amount of epidural hemorrhage occurred during the procedure. There were 3 cases of symptomatic brain edema after brachytherapy treatment, including grade three toxicity in 1 case and grade two toxicity in 2 cases. The three patients were treated with corticosteroid for 2 to 4 weeks. The clinical symptoms related to brain edema were significantly alleviated thereafter. Conclusions 3DNPT combined with open MR-guided 125I brachytherapy for circumscribed recurrent glioblastoma is feasible, effective, and with low risk of complications. Postoperative dosimetry matched the preoperative treatment plan. The described method can be used as a novel implantation technique for 125I brachytherapy in the treatment of recurrent gliomas. Trial registration The study was approved by the Institutional Review Board of Shandong Provincial Hospital Affiliated to Shandong University (NSFC:NO.2017–058), registered 1st July 2017.
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Affiliation(s)
- Xiangmeng He
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | - Ming Liu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | - Menglong Zhang
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | | | - Yujun Xu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | - Ligang Wang
- Department of Medical Imaging and Interventional Radiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, People's Republic of China
| | - Chao Liu
- Department of Tumor Minimally Invasive, Tai'an Central Hospital, Tai'an, Shandong, People's Republic of China
| | - Qingwen Wang
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | - Kai Zhang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Chengli Li
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China.
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Chammas M, Saadeh F, Maaliki M, Assi H. Therapeutic Interventions in Adult Low-Grade Gliomas. J Clin Neurol 2018; 15:1-8. [PMID: 30198226 PMCID: PMC6325362 DOI: 10.3988/jcn.2019.15.1.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 01/05/2023] Open
Abstract
Treating adult low-grade gliomas (LGGs) is particularly challenging due to the highly infiltrative nature of this type of brain cancer. Although surgery, radiotherapy, and chemotherapy are the mainstay treatment modalities for LGGs, the optimal combination management plan for a particular patient based on individual symptoms and the risk of treatment-induced toxicity remains unclear. This review highlights the competency and limitations of standard treatment options while providing an essential therapeutic update regarding current clinical trials aimed at implementing targeted therapies with morbidity rates lower than those for current LGG treatments and also augmenting the killing of cancerous cells while maintaining an improved quality of life.
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Affiliation(s)
- Majid Chammas
- American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Fadi Saadeh
- American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Maya Maaliki
- American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Hazem Assi
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.
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Zheng J, Wang C, Liu F. Stereotactic Brachytherapy with Iodine-125 Seeds Plus Temozolomide Induced Complete and Durable Remission in a Patient with Recurrent Primary Central Nervous System Lymphoma. World Neurosurg 2018; 117:316-320. [PMID: 29960094 DOI: 10.1016/j.wneu.2018.06.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/17/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The optimal treatment of recurrent primary central nervous system lymphoma (PCNSL) has not yet been determined. We report a patient with recurrent PCNSL who has been successfully treated with stereotactic brachytherapy (SBT) with iodine-125 seeds plus temozolomide (TMZ). CASE DESCRIPTION A 51-year-old man who underwent left occipital lobe tumor resection 11 years earlier presented with a 1-month history of right hand weakness. Magnetic resonance imaging (MRI) revealed a recurrent PCNSL, which was confirmed by pathological examination. He was treated with SBT plus TMZ. At 1 month after surgery, a repeat MRI revealed nearly complete disappearance of the lesion. At 13.5 months postsurgery, the patient was neurologically intact except for right homonymous hemianopia, and follow-up MRI did not reveal a recurrent tumor. CONCLUSIONS To our knowledge, this is the first case of recurrent PCNSL successfully treated with SBT plus TMZ. Further randomized studies are needed to confirm the therapeutic impact of this new method.
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Affiliation(s)
- Jian Zheng
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chun Wang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fengqiang Liu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Investigation of Newly Prepared Biodegradable 32P-chromic Phosphate-polylactide-co-glycolide Seeds and Their Therapeutic Response Evaluation for Glioma Brachytherapy. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:2630480. [PMID: 29853804 PMCID: PMC5949199 DOI: 10.1155/2018/2630480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/14/2018] [Indexed: 12/15/2022]
Abstract
32P high-dose rate brachytherapy allows high-dose radiation delivery to target lesions with less damage to adjacent tissues. The early evaluation of its therapeutic effect on tumours is vital for the optimization of treatment regimes. The most commonly used 32P-CP colloid tends to leak with blind therapeutic area after intratumour injection. We prepared 32P-chromic phosphate-polylactide-co-glycolide (32P-CP-PLGA) seeds with biodegradable PLGA as a framework and investigated their characteristics in vitro and in vivo. We also evaluated the therapeutic effect of 32P-CP-PLGA brachytherapy for glioma with the integrin αvβ3-targeted radiotracer 68Ga-3PRGD2. 32P-CP-PLGA seeds (seed group, SG, 185 MBq) and 32P-CP colloid (colloid group, CG, 18.5 MBq) were implanted or injected into human glioma xenografts in nude mice. Scanning electron microscopy (SEM) of the seeds, micro-SPECT imaging, and biodistribution studies were performed at different time points. The tumour volume was measured using a caliper, and 68Ga-3PRGD2 micro-PET-CT imaging was performed to evaluate the therapeutic effect after 32P intratumour administration. The delayed release of 32P-CP was observed with biodegradation of vehicle PLGA. Intratumoural effective half-life of 32P-CP in the SG (13.3 ± 0.3) d was longer than that in the CG (10.4 ± 0.3) d (P < 0.05), with liver appearance in the CG on SPECT. A radioactivity gradient developed inside the tumour in the SG, as confirmed by micro-SPECT and SEM. Tumour uptake of 68Ga-3PRGD2 displayed a significant increase on day 0.5 in the SG and decreased earlier (on day 2) than the volume reduction (on day 8). Thus, 32P-CP-PLGA seeds, controlling the release of entrapped 32P-CP particles, are promising for glioma brachytherapy, and 68Ga-3PRGD2 imaging shows potential for early response evaluation of 32P-CP-PLGA seeds brachytherapy.
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14
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Gao Y, Han Y, Nan G, Hu M, Zhou X, Hu X. Value of CT-MRI fusion in iodine-125 brachytherapy for high-grade glioma. Oncotarget 2017; 8:112883-112892. [PMID: 29348874 PMCID: PMC5762559 DOI: 10.18632/oncotarget.22844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022] Open
Abstract
Purposes To develop a fast, accurate and robust method of fusing Computed Tomography (CT) with pre-operative Magnetic Resonance Imaging (MRI) and evaluate the impact of using the fused data on the implantation of Iodine-125 (125I) seeds for brachytherapy of high-grade gliomas (HGG). Methods A study was performed on a cohort of 10 consecutive patients with HGG were treated by 125I brachytherapy with CT-MRI fusion image guided (CMGB), and 10 patients treated with CT alone guided (CGB). Statistical analysis was performed to compare (1) the planning target volume, (2) the accuracy of location of catheters, (3) the target volume covered by 150% prescribe dose (V150), (4) the target volume covered by 200% prescribe dose (V200), and (5) the conformity index (CI) with or without fused data. Results The median planning target volume was 50.1 cm3 in CGB, and 56.25 cm3 in CMGB with significant difference (p = 0.005). The accuracy of catheter insertion was 94.4% with CMGB and 78.9% with CGB. The median V150 and V200 was 45.32% vs 64.24% and 32.81% vs 53.17% in CGB and CMGB, respectively. There was significant difference for CI (83.5% vs. 74.5%, p < 0.05) in the two groups for the post-operative verification. Conclusions The proposed MRI-CT fusion method enables a quantitative assessment of impact on HGG brachytherapy. The additional information obtained from the fused images can be utilized for more accurate delineation of lesion boundaries and targeting of catheters. Experimental results show that the fusion algorithm is robust and reliable in clinical practice.
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Affiliation(s)
- Yang Gao
- School of Instrumentation Science and Opto-Electronics Engineering, Beihang University, Beijing 100191, China
| | - Yan Han
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266001, China
| | - Guo Nan
- School of Instrumentation Science and Opto-Electronics Engineering, Beihang University, Beijing 100191, China
| | - Man Hu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan 250117 China
| | - Xiaobin Zhou
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao 266021, China
| | - Xiaokun Hu
- Interventional Center, The Affiliated Hospital of Qingdao University, Qingdao 266001, China
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Henares-Molina A, Benzekry S, Lara PC, García-Rojo M, Pérez-García VM, Martínez-González A. Non-standard radiotherapy fractionations delay the time to malignant transformation of low-grade gliomas. PLoS One 2017; 12:e0178552. [PMID: 28570587 PMCID: PMC5453550 DOI: 10.1371/journal.pone.0178552] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/15/2017] [Indexed: 12/15/2022] Open
Abstract
Grade II gliomas are slowly growing primary brain tumors that affect mostly young patients. Cytotoxic therapies (radiotherapy and/or chemotherapy) are used initially only for patients having a bad prognosis. These therapies are planned following the “maximum dose in minimum time” principle, i. e. the same schedule used for high-grade brain tumors in spite of their very different behavior. These tumors transform after a variable time into high-grade gliomas, which significantly decreases the patient’s life expectancy. In this paper we study mathematical models describing the growth of grade II gliomas in response to radiotherapy. We find that protracted metronomic fractionations, i.e. therapeutical schedules enlarging the time interval between low-dose radiotherapy fractions, may lead to a better tumor control without an increase in toxicity. Other non-standard fractionations such as protracted or hypoprotracted schemes may also be beneficial. The potential survival improvement depends on the tumor’s proliferation rate and can be even of the order of years. A conservative metronomic scheme, still being a suboptimal treatment, delays the time to malignant progression by at least one year when compared to the standard scheme.
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Affiliation(s)
- Araceli Henares-Molina
- Department of Mathematics, University of Castilla-La Mancha, Ciudad Real, Castilla-La Mancha, Spain
| | - Sebastien Benzekry
- INRIA Bordeaux Sud-Ouest, team MONC, Institut de Mathematiques de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France
| | - Pedro C Lara
- Department of Radiation Oncology, Negrín Las Palmas University Hospital, Las Palmas GC, Canarias, Spain
| | - Marcial García-Rojo
- Department of Pathology, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain
| | - Víctor M Pérez-García
- Department of Mathematics, University of Castilla-La Mancha, Ciudad Real, Castilla-La Mancha, Spain
| | - Alicia Martínez-González
- Department of Mathematics, University of Castilla-La Mancha, Ciudad Real, Castilla-La Mancha, Spain
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Suchorska B, Hamisch C, Treuer H, Mahnkopf K, Lehrke RE, Kocher M, Ruge MI, Voges J. Stereotactic brachytherapy using iodine 125 seeds for the treatment of primary and recurrent anaplastic glioma WHO° III. J Neurooncol 2016; 130:123-131. [PMID: 27422129 DOI: 10.1007/s11060-016-2214-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
The current study analyzed the outcome after stereotactic brachytherapy (SBT) using iodine-125 seeds in anaplastic astrocytoma, oligoastrocytoma or oligodendroglioma not suitable for resection. Out of 223 patients harbouring a malignant glioma treated according to a prospective protocol, 172 patients were selected who received SBT to treat a WHO grade III de-novo/residual tumor (n = 99) or a tumor recurrence after multimodal treatment (n = 73). We assessed progression free survival (PFS), overall survival (OS), radiological and clinical outcome and determined prognostic factors using univariate and multivariate regression analyses. The median follow-up time was 38 months. Median OS and median PFS was 28.9 and 21.4 months in the de-novo group vs. 49.4 and 32.6 months in the recurrence group. Recurrent tumors had more frequently (p = 0.01) an oligodendroglial-component compared to de novo tumors. According to cohort-specific univariate analyses KPS at SBT had a significant (p = 0.008) impact on OS in the de-novo group. In the recurrence group, (Cox regression analysis) OS was significantly associated with histology subtype (oligoastro-/oligodendroglioma vs. astrocytoma, p = 0.043). Transient and permanent morbidity (~1 %) was low. For patients unable to undergo surgery due to eloquent tumour location or reduced general condition SBT is an effective treatment option, which does not foreclose additional therapeutic interventions.
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Affiliation(s)
- B Suchorska
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany.,Department of Neurosurgery, Ludwig Maximilians University of Munich, Munich, Germany
| | - C Hamisch
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University of Cologne, Cologne, Germany.,Department of Neurosurgery, Centre of Neurosurgery, University of Cologne, Cologne, Germany
| | - H Treuer
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University of Cologne, Cologne, Germany
| | - K Mahnkopf
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - R E Lehrke
- Department of Stereotactic Neurosurgery, St. Barbara Hospital, Hamm, Germany
| | - M Kocher
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - M I Ruge
- Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University of Cologne, Cologne, Germany
| | - J Voges
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany. .,Leibniz Institute for Neurobiology, Magdeburg, Germany.
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17
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Rueß D, Kocher M, Treuer H, Ruge MI. [Computer-controlled high-precision radiation]. HNO 2016; 65:19-24. [PMID: 27393294 DOI: 10.1007/s00106-016-0207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The irradiation of tumors in the brain is challenging due to the proximity of radiation sensitive critical structures and the tumors to be treated. In addition, irradiation above a certain level can cause irreversible damage to nerve tissue. The irradiation of benign and malignant brain tumors requires precise techniques to preserve critical structures while simultaneously administering a high radiation dose for maximum effectiveness. Therefore, stereotaxy, as a subspecialty of neurosurgery, has developed various irradiation techniques, e. g., intracerebral application of interstitial brachytherapy (SBT; stereotactic brachytherapy) and stereotactic radiosurgery (SRS). Due to the development of computer-controlled radiation techniques (e. g., Cyberknife) over the last 20 years, SRS has gained increasing importance.
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Affiliation(s)
- D Rueß
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - M Kocher
- Klinik und Poliklinik für Strahlentherapie, Uniklinik Köln, Köln, Deutschland
| | - H Treuer
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - M I Ruge
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
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18
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Ruge MI, Rueß D, Hellerbach A, Treuer H. Letter to the Editor: Low dose rate brachytherapy for the treatment of brain metastases. J Neurosurg 2015; 123:1110-1. [DOI: 10.3171/2015.2.jns15195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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19
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Stereotactic interstitial brachytherapy for the treatment of oligodendroglial brain tumors. Strahlenther Onkol 2015; 191:936-44. [PMID: 26307628 DOI: 10.1007/s00066-015-0887-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We evaluated the treatment of oligodendroglial brain tumors with interstitial brachytherapy (IBT) using (125)iodine seeds ((125)I) and analyzed prognostic factors. PATIENTS AND METHODS Between January 1991 and December 2010, 63 patients (median age 43.3 years, range 20.8-63.4 years) suffering from oligodendroglial brain tumors were treated with (125)I IBT either as primary, adjuvantly after incomplete resection, or as salvage therapy after tumor recurrence. Possible prognostic factors influencing disease progression and survival were retrospectively investigated. RESULTS The actuarial 2-, 5-, and 10-year overall and progression-free survival rates after IBT for WHO II tumors were 96.9, 96.9, 89.8 % and 96.9, 93.8, 47.3 %; for WHO III tumors 90.3, 77, 54.9 % and 80.6, 58.4, 45.9 %, respectively. Magnetic resonance imaging demonstrated complete remission in 2 patients, partial remission in 13 patients, stable disease in 17 patients and tumor progression in 31 patients. Median time to progression for WHO II tumors was 87.6 months and for WHO III tumors 27.8 months. Neurological status improved in 10 patients and remained stable in 20 patients, while 9 patients deteriorated. There was no treatment-related mortality. Treatment-related morbidity was transient in 11 patients. WHO II, KPS ≥ 90 %, frontal location, and tumor surface dose > 50 Gy were associated with increased overall survival (p ≤ 0.05). Oligodendroglioma and frontal location were associated with a prolonged progression-free survival (p ≤ 0.05). CONCLUSION Our study indicates that IBT achieves local control rates comparable to surgery and radio-/chemotherapy treatment, is minimally invasive, and safe. Due to the low rate of side effects, IBT may represent an attractive option as part of a multimodal treatment schedule, being supplementary to microsurgery or as a salvage therapy after chemotherapy and conventional irradiation.
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20
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Man K, Sabourin VM, Gandhi CD, Carmel PW, Prestigiacomo CJ. Pierre Curie: the anonymous neurosurgical contributor. Neurosurg Focus 2015; 39:E7. [PMID: 26126406 DOI: 10.3171/2015.4.focus15102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pierre Curie, best known as a Nobel Laureate in Physics for his co-contributions to the field of radioactivity alongside research partner and wife Marie Curie, died suddenly in 1906 from a street accident in Paris. Tragically, his skull was crushed under the wheel of a horse-drawn carriage. This article attempts to honor the life and achievements of Pierre Curie, whose trailblazing work in radioactivity and piezoelectricity set into motion a wide range of technological developments that have culminated in the advent of numerous techniques used in neurological surgery today. These innovations include brachytherapy, Gamma Knife radiosurgery, focused ultrasound, and haptic feedback in robotic surgery.
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Affiliation(s)
- Karen Man
- Departments of 1 Neurological Surgery
| | | | - Chirag D Gandhi
- Departments of 1 Neurological Surgery.,Radiology.,Neurology and Neuroscience, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Charles J Prestigiacomo
- Departments of 1 Neurological Surgery.,Radiology.,Neurology and Neuroscience, Rutgers New Jersey Medical School, Newark, New Jersey
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21
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Low-dose rate stereotactic iodine-125 brachytherapy for the treatment of inoperable primary and recurrent glioblastoma: single-center experience with 201 cases. J Neurooncol 2014; 120:615-23. [DOI: 10.1007/s11060-014-1595-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 08/17/2014] [Indexed: 10/24/2022]
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22
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Zhao D, Qian L, Shen J, Liu X, Mei K, Cen J, Wang Y, Li C, Ma Y. Combined treatment of rituximab, idarubicin, dexamethasone, cytarabine, methotrexate with radiotherapy for primary central nervous system lymphoma. J Cell Mol Med 2014; 18:1081-6. [PMID: 24628986 PMCID: PMC4508147 DOI: 10.1111/jcmm.12252] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/21/2014] [Indexed: 12/01/2022] Open
Abstract
The overall response rates and long-term survival of primary central nervous system lymphoma (PCNSL) are still significantly inferior to the results achieved in similar subtypes of extranodal non-Hodgkin's lymphoma. It is clearly necessary to investigate new therapeutic methods on PCNSL. We encountered three patients histologically documented PCNSL as diffuse large B-cell lymphoma (DLBCL). They were treated with R-IDARAM which comprised rituximab, idarubicin, dexamethasone, cytarabine and methotrexate. Patient 1 received stereotactic brachytherapy (SBT) prior to chemotherapy performed with iodine-125 seeds (cumulative therapeutic dose 50 Gy). After six cycles of R-IDARAM at 3-weekly intervals, radiotherapy was applied at a dosage of 2000–4000 cGy in conventional schedule (180 or 200 cGy/day) to whole brain or spinal cord in all patients. Complete remission (CR) was achieved after first two cycles of R-IDARAM in all patients. All three patients remained in CR at the time of this report with a median duration of follow-up of 23 months (ranging from 13 to 41 months). Three patients have been alive for 41, 13, 16 months respectively until now. The patient with the longest survival time was the one given SBT prior to chemotherapy. This study suggests that R-IDARAM combining with radiotherapy maybe a high effective regimen in PCNSL patients especially those with primary central nervous system DLBCL. A comprehensive treatment combining internal radiotherapy by SBT, modified R-IDARAM and followed reduced external radiotherapy may be a new treatment concept for PCNSL with higher efficiency and lower toxicity.
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Affiliation(s)
- Defeng Zhao
- Department of Hematology, Navy General Hospital of PLA, Beijing, China
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